Provider Demographics
NPI:1558572941
Name:AMERICARE AMBULANCE SERVICE OF LAFAYETTE, LLC
Entity Type:Organization
Organization Name:AMERICARE AMBULANCE SERVICE OF LAFAYETTE, LLC
Other - Org Name:AMERICARE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-770-1100
Mailing Address - Street 1:8001 EAST 196TH STREET
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9091
Mailing Address - Country:US
Mailing Address - Phone:317-770-1100
Mailing Address - Fax:317-770-7002
Practice Address - Street 1:3535 CROUCH ST STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0741
Practice Address - Country:US
Practice Address - Phone:765-449-7100
Practice Address - Fax:765-449-7125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0944341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00407900OtherMEDICARE RAILROAD
IN200864260AMedicaid
IN200864260AMedicaid