Provider Demographics
NPI:1821189960
Name:S-W RESCUE SERVICE, INC.
Entity Type:Organization
Organization Name:S-W RESCUE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSCOYOC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-866-0625
Mailing Address - Street 1:PO BOX 2915
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-2915
Mailing Address - Country:US
Mailing Address - Phone:574-293-3030
Mailing Address - Fax:574-294-1345
Practice Address - Street 1:ALLEY OFF 3RD STREET
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:IN
Practice Address - Zip Code:47965
Practice Address - Country:US
Practice Address - Phone:765-866-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN03073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100287220AMedicaid
P00142546OtherRRMC PTAN
IN000000246716OtherANTHEM
IN100287220AMedicaid
P00142546OtherRRMC PTAN