Provider Demographics
NPI:1770859175
Name:PROMPT AMBULANCE CENTRAL, INC.
Entity Type:Organization
Organization Name:PROMPT AMBULANCE CENTRAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:1600 KEPNER DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905
Mailing Address - Country:US
Mailing Address - Phone:765-448-4327
Mailing Address - Fax:765-448-4694
Practice Address - Street 1:1600 KEPNER DR
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7427
Practice Address - Country:US
Practice Address - Phone:765-448-4327
Practice Address - Fax:765-448-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01503416L0300X
INM300068597341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201062000AMedicaid
INP01089849OtherRAILROAD MEDICARE
IN201062000AMedicaid