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General NPI Number Information
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NPI Number | 1093933228
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Entity Type | Organization
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Legal Business Name | RUSSIAVILLE AMBULANCE SERVICE INC.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 250 N UNION ST
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City | RUSSIAVILLE
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State | IN
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Zip | 46979
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Country | US
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Telephone | 765-889-3059
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Fax | 765-889-3059
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Provider Business Mailing Address
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Address Line | 250 N UNION ST P.O. BOX 278
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City | RUSSIAVILLE
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State | IN
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Zip | 46979
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Country | US
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Telephone | 765-889-3059
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Fax | 765-889-3059
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KEVIN R REDDING SR.
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Credential | DIRECTOR
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Telephone | 765-883-5386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 0260
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License Number State | IN
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