Provider Demographics
NPI:1306009790
Name:MIDWEST AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:MIDWEST AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-548-4044
Mailing Address - Street 1:PO BOX 421723
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46242
Mailing Address - Country:US
Mailing Address - Phone:317-548-4044
Mailing Address - Fax:317-857-1481
Practice Address - Street 1:8450 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-1382
Practice Address - Country:US
Practice Address - Phone:317-548-4044
Practice Address - Fax:317-857-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1130341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1130Other1130 CERT