Provider Demographics
NPI:1912766197
Name:PHOENIX PARAMEDIC SOLUTIONS; LLC
Entity Type:Organization
Organization Name:PHOENIX PARAMEDIC SOLUTIONS; LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-448-4327
Mailing Address - Street 1:3554 PROMENADE PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8418
Mailing Address - Country:US
Mailing Address - Phone:765-637-7161
Mailing Address - Fax:
Practice Address - Street 1:3554 PROMENADE PKWY STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8418
Practice Address - Country:US
Practice Address - Phone:765-637-7161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2131-0-ASOOtherADDICTIONS SERVICES PROVIDER-OUTPATIENT