Provider Demographics
NPI:1891704342
Name:WHEATFIELD AMBULANCE SERVICE
Entity Type:Organization
Organization Name:WHEATFIELD AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-956-4865
Mailing Address - Street 1:3134 MALLARD COVE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2882
Mailing Address - Country:US
Mailing Address - Phone:260-436-9495
Mailing Address - Fax:260-436-7235
Practice Address - Street 1:490 E GROVE ST
Practice Address - Street 2:
Practice Address - City:WHEATFIELD
Practice Address - State:IN
Practice Address - Zip Code:46392
Practice Address - Country:US
Practice Address - Phone:219-956-4865
Practice Address - Fax:219-956-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN03733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000237787OtherANTHEM
IN000000237787OtherANTHEM
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