Healthcare Provider Details

I. General information

NPI: 1760501969
Provider Name (Legal Business Name): STAT AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 CENTRAL AVE
COLUMBUS IN
47201-5326
US

IV. Provider business mailing address

1704 CENTRAL AVE
COLUMBUS IN
47201-5326
US

V. Phone/Fax

Practice location:
  • Phone: 812-379-9111
  • Fax: 812-379-9539
Mailing address:
  • Phone: 812-379-9111
  • Fax: 812-379-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0541
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number29203-A
License Number StateIN

VIII. Authorized Official

Name: MR. ANDREW JASON VEST
Title or Position: VICE PRESIDENT
Credential:
Phone: 812-379-9111