Provider Demographics
NPI:1033222872
Name:FAMILY MOBILE MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:FAMILY MOBILE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-736-8820
Mailing Address - Street 1:1370 E 86TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6340
Mailing Address - Country:US
Mailing Address - Phone:219-736-8820
Mailing Address - Fax:219-736-8803
Practice Address - Street 1:1370 E 86TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6340
Practice Address - Country:US
Practice Address - Phone:219-736-8820
Practice Address - Fax:219-736-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0465341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1033222872Medicare UPIN
IN407710Medicare ID - Type Unspecified