Healthcare Provider Details

I. General information

NPI: 1174528335
Provider Name (Legal Business Name): SEALS AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ROOSEVELT AVE
INDIANAPOLIS IN
46218-4214
US

IV. Provider business mailing address

PO BOX 660884
DALLAS TX
75266-0884
US

V. Phone/Fax

Practice location:
  • Phone: 844-597-4911
  • Fax: 866-687-2796
Mailing address:
  • Phone: 844-597-4911
  • Fax: 866-687-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0182
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number28771
License Number StateIN

VIII. Authorized Official

Name: ROBERT A JEWELL
Title or Position: CHIEF REVENUE INTEGRATION OFFICER
Credential:
Phone: 844-597-4911