Healthcare Provider Details

I. General information

NPI: 1497111801
Provider Name (Legal Business Name): MISSION MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BUCKINGHAM WAY
LOGANSPORT IN
46947-2465
US

IV. Provider business mailing address

PO BOX 415000 MSC 8013
NASHVILLE TN
37241-8013
US

V. Phone/Fax

Practice location:
  • Phone: 574-225-1551
  • Fax:
Mailing address:
  • Phone: 317-849-6628
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MIKE FORT
Title or Position: OWNER
Credential: NREMT-I
Phone: 317-775-6751