Provider Demographics
NPI:1467809921
Name:HOOSIER MED TRANSPORT SERVICES
Entity Type:Organization
Organization Name:HOOSIER MED TRANSPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-440-3043
Mailing Address - Street 1:902 AUTUMN LAKES CIR # A
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-8934
Mailing Address - Country:US
Mailing Address - Phone:574-440-3043
Mailing Address - Fax:
Practice Address - Street 1:902 AUTUMN LAKES CIR # A
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-8934
Practice Address - Country:US
Practice Address - Phone:574-440-3043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1234563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherFEDERAL TAX ID