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General NPI Number Information
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NPI Number | 1083984777
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Entity Type | Organization
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Legal Business Name | ROLL WITH US,LLC.
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 3619 W COUNTY ROAD 300 N
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City | CONNERSVILLE
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State | IN
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Zip | 47331-9742
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Country | US
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Telephone | 765-265-1348
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Fax |
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Provider Business Mailing Address
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Address Line | 3619 W COUNTY ROAD 300 N
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City | CONNERSVILLE
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State | IN
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Zip | 47331-9742
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Country | US
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Telephone | 765-265-1348
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Fax |
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Authorized Official
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Title or Position | RPC
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Name | ERICA ANN GAINES
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Credential | PTA
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Telephone | 765-265-1348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 0300127728
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License Number State | IN
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