Provider Demographics
NPI:1003812637
Name:AMBULANCE ENTERPRISES, INC D/B/A INDIANA EMS
Entity Type:Organization
Organization Name:AMBULANCE ENTERPRISES, INC D/B/A INDIANA EMS
Other - Org Name:INDIANA EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MGR.
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-289-0725
Mailing Address - Street 1:2816 W. SAMPLE ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-3230
Mailing Address - Country:US
Mailing Address - Phone:574-289-0725
Mailing Address - Fax:579-289-4662
Practice Address - Street 1:2816 W. SAMPLE ST.
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3230
Practice Address - Country:US
Practice Address - Phone:574-289-0725
Practice Address - Fax:579-289-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
IN03983416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100101400AMedicaid
IN100101400AMedicaid
IN987670Medicare PIN