Provider Demographics
NPI:1407842164
Name:MC AMBULANCE SERVICE, LLC.
Entity Type:Organization
Organization Name:MC AMBULANCE SERVICE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:A-EMT
Authorized Official - Phone:812-636-7888
Mailing Address - Street 1:10770 N 600 E
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562
Mailing Address - Country:US
Mailing Address - Phone:812-636-7888
Mailing Address - Fax:
Practice Address - Street 1:10770 N 600 E
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562
Practice Address - Country:US
Practice Address - Phone:812-636-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0752OtherIN STATE EMS CERT #
IN177640Medicare ID - Type Unspecified