Provider Demographics
NPI:1225404338
Name:MED ONE MOBILE LLC
Entity Type:Organization
Organization Name:MED ONE MOBILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:WIREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-249-8123
Mailing Address - Street 1:4104 S STATE ROAD 39
Mailing Address - Street 2:
Mailing Address - City:NORTH JUDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46366-8652
Mailing Address - Country:US
Mailing Address - Phone:574-249-8123
Mailing Address - Fax:
Practice Address - Street 1:4104 S STATE ROAD 39
Practice Address - Street 2:
Practice Address - City:NORTH JUDSON
Practice Address - State:IN
Practice Address - Zip Code:46366-8652
Practice Address - Country:US
Practice Address - Phone:574-249-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance