Provider Demographics
NPI:1760605224
Name:TRI- CREEK AMBULANCE SERVICE AGENCY INC
Entity Type:Organization
Organization Name:TRI- CREEK AMBULANCE SERVICE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-696-8610
Mailing Address - Street 1:1331 E COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2168
Mailing Address - Country:US
Mailing Address - Phone:219-696-6108
Mailing Address - Fax:219-690-1224
Practice Address - Street 1:1331 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2168
Practice Address - Country:US
Practice Address - Phone:219-696-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100281600AMedicaid
IN590164481OtherPALMETTO
IN255730Medicare PIN