Provider Demographics
NPI:1497111801
Name:MISSION MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:MISSION MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-I
Authorized Official - Phone:317-775-6751
Mailing Address - Street 1:PO BOX 415000 MSC 8013
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-8013
Mailing Address - Country:US
Mailing Address - Phone:317-849-6628
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:305 BUCKINGHAM WAY
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2465
Practice Address - Country:US
Practice Address - Phone:574-225-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport