Provider Demographics
NPI:1093933228
Name:RUSSIAVILLE AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:RUSSIAVILLE AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:SR
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:765-883-5386
Mailing Address - Street 1:250 N UNION ST
Mailing Address - Street 2:P.O. BOX 278
Mailing Address - City:RUSSIAVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46979
Mailing Address - Country:US
Mailing Address - Phone:765-889-3059
Mailing Address - Fax:765-889-3059
Practice Address - Street 1:250 N UNION ST
Practice Address - Street 2:
Practice Address - City:RUSSIAVILLE
Practice Address - State:IN
Practice Address - Zip Code:46979
Practice Address - Country:US
Practice Address - Phone:765-889-3059
Practice Address - Fax:765-889-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
INRU979390Medicaid
IN212790Medicare ID - Type Unspecified