Provider Demographics
NPI:1982076550
Name:MED ONE MOBILE
Entity Type:Organization
Organization Name:MED ONE MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-249-8123
Mailing Address - Street 1:4104 S STATE ROAD 39
Mailing Address - Street 2:
Mailing Address - City:NORTH JUDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46366
Mailing Address - Country:US
Mailing Address - Phone:574-249-8123
Mailing Address - Fax:
Practice Address - Street 1:4104 S STATE ROAD 39
Practice Address - Street 2:
Practice Address - City:NORTH JUDSON
Practice Address - State:IN
Practice Address - Zip Code:46366
Practice Address - Country:US
Practice Address - Phone:574-249-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport