Provider Demographics
NPI:1578757290
Name:NORTHWEST AMBULANCE SERVICES INC
Entity Type:Organization
Organization Name:NORTHWEST AMBULANCE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:NNAMDY
Authorized Official - Last Name:UBANWA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-756-6607
Mailing Address - Street 1:100 W 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5439
Mailing Address - Country:US
Mailing Address - Phone:219-756-6667
Mailing Address - Fax:
Practice Address - Street 1:100 W 79TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5439
Practice Address - Country:US
Practice Address - Phone:219-756-6667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INPENDING341600000X
INPENDING (NEW APP)3416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDING (NEW APPL)Medicaid