=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346419496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTSAVERS EMS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2008
-----------------------------------------------------
Last Update Date | 07/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 CENTRAL AVE
-----------------------------------------------------
City | CONNERSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47331-0445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-827-4010
-----------------------------------------------------
Fax | 765-827-4013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3645 E MAIN ST # 168
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47374-5934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-827-4010
-----------------------------------------------------
Fax | 765-827-4013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MR. GEORGE RICHARD MUNS
-----------------------------------------------------
Credential | LPN,EMT
-----------------------------------------------------
Telephone | 765-827-4010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 1104
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1104
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------