Provider Demographics
NPI:1033393285
Name:AMERICARE AMBULANCE SERVICE OF BRADLEY A OTT MBR
Entity Type:Organization
Organization Name:AMERICARE AMBULANCE SERVICE OF BRADLEY A OTT MBR
Other - Org Name:AMERICARE AMBULANCE SERVICE OF MUNCIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-770-1100
Mailing Address - Street 1:8001 EAST 196TH STREET
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9091
Mailing Address - Country:US
Mailing Address - Phone:317-770-1100
Mailing Address - Fax:317-770-7002
Practice Address - Street 1:4651 W WOODS EDGE LN
Practice Address - Street 2:SUITE # 4
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6088
Practice Address - Country:US
Practice Address - Phone:765-863-9115
Practice Address - Fax:765-282-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1111341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200888630AMedicaid
IN000000598025OtherANTHEM
INP00706044OtherRAILROAD MEDICARE
IN000000598025OtherANTHEM