Provider Demographics
NPI:1891128153
Name:BRADLEY BOLINGER
Entity Type:Organization
Organization Name:BRADLEY BOLINGER
Other - Org Name:INTEGRA AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-821-1025
Mailing Address - Street 1:23 N ALTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-3908
Mailing Address - Country:US
Mailing Address - Phone:317-625-7000
Mailing Address - Fax:888-446-6791
Practice Address - Street 1:23 N ALTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-3908
Practice Address - Country:US
Practice Address - Phone:317-821-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0989341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance