Provider Demographics
NPI:1265533467
Name:SUNMAN AREA LIFE SQUAD, INC.
Entity type:Organization
Organization Name:SUNMAN AREA LIFE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-623-2763
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:574-293-3030
Mailing Address - Fax:574-294-1345
Practice Address - Street 1:403 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:SUNMAN
Practice Address - State:IN
Practice Address - Zip Code:47041
Practice Address - Country:US
Practice Address - Phone:812-623-2763
Practice Address - Fax:812-623-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00164852OtherRRMC
IN000000303775OtherANTHEM
IN200297690AMedicaid
IN000000303775OtherANTHEM
IN=========OtherTRICARE