Provider Demographics
NPI:1376541342
Name:TRI-COUNTY AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:TRI-COUNTY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:574-862-3105
Mailing Address - Street 1:615 NELSONS PKWY
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-9580
Mailing Address - Country:US
Mailing Address - Phone:574-862-3150
Mailing Address - Fax:574-862-7951
Practice Address - Street 1:615 NELSONS PKWY
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:IN
Practice Address - Zip Code:46573-9580
Practice Address - Country:US
Practice Address - Phone:574-862-3150
Practice Address - Fax:574-862-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000190132OtherBLUE CROSS BLUE SHIELD
IN200222430Medicaid
IN590013921OtherRAILROAD MEDICARE
IN000000190132OtherBLUE CROSS BLUE SHIELD