Provider Demographics
NPI:1760501969
Name:STAT AMBULANCE INC
Entity Type:Organization
Organization Name:STAT AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:VEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-379-9111
Mailing Address - Street 1:1704 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5326
Mailing Address - Country:US
Mailing Address - Phone:812-379-9111
Mailing Address - Fax:812-379-9539
Practice Address - Street 1:1704 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5326
Practice Address - Country:US
Practice Address - Phone:812-379-9111
Practice Address - Fax:812-379-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0541341600000X
IN29203-A343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000192165OtherANTHEM
IN590012348OtherPALMETTO GOV'T SERVICES
IN200147760AMedicaid
IN590012348OtherPALMETTO GOV'T SERVICES