Provider Demographics
NPI:1538124656
Name:PROMPT MEDICAL TRANSPORTATION INC
Entity Type:Organization
Organization Name:PROMPT MEDICAL TRANSPORTATION INC
Other - Org Name:PROMPT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-838-4444
Mailing Address - Street 1:9835 EXPRESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322
Mailing Address - Country:US
Mailing Address - Phone:219-934-1010
Mailing Address - Fax:219-924-3192
Practice Address - Street 1:9835 EXPRESS DRIVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322
Practice Address - Country:US
Practice Address - Phone:219-934-1010
Practice Address - Fax:219-924-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000111849OtherANTHEM
WI82347500Medicaid
MN218639000Medicaid
IN200201550AMedicaid
590012916OtherRAILROAD MEDICARE
WI82347500Medicaid
IL=========001Medicaid