MEDICARE: PHOENIX PARAMEDIC SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1346953965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PARAMEDIC SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	3535 MCCARTY LN
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4985
Country	:	US
Telephone Number	:	765-237-4129
Fax Number	:

Provider Business Practice Location Address
First Line	:	3554 PROMENADE PKWY
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-8417
Country	:	US
Telephone Number	:	765-637-7161
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NATHANIEL A METZ
Credential	:
Telephone Number	:	765-448-4327

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	04/23/2024

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