Healthcare Provider Details

I. General information

NPI: 1265533467
Provider Name (Legal Business Name): SUNMAN AREA LIFE SQUAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N MERIDIAN ST
SUNMAN IN
47041
US

IV. Provider business mailing address

PO BOX 392907
PITTSBURGH PA
15251-9907
US

V. Phone/Fax

Practice location:
  • Phone: 812-623-2763
  • Fax: 812-623-5100
Mailing address:
  • Phone: 574-293-3030
  • Fax: 574-294-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0004
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00164852
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerRRMC
# 2
Identifier000000303775
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM
# 3
Identifier200297690A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name: BRIAN MAYNARD
Title or Position: CHIEF OF EMS
Credential:
Phone: 812-623-2763