Provider Demographics
NPI:1912011172
Name:ST MARYS WARRICK EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:ST MARYS WARRICK EMERGENCY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-897-7143
Mailing Address - Street 1:7669 SOLUTION CTR
Mailing Address - Street 2:LOCKBOX 777669
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0076
Mailing Address - Country:US
Mailing Address - Phone:812-897-7078
Mailing Address - Fax:
Practice Address - Street 1:415 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-1809
Practice Address - Country:US
Practice Address - Phone:812-897-7078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0069341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00387546OtherRR MEDICARE
IN200836200AMedicaid
IN200836200AMedicaid