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General NPI Number Information
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NPI Number | 1861499139
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Entity Type | Organization
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Legal Business Name | THREE RIVERS AMBULANCE AUTHORITY
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 525 HAYDEN ST
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City | FORT WAYNE
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State | IN
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Zip | 46802-3550
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Country | US
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Telephone | 260-420-6500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11724 525 HAYDEN ST
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City | FORT WAYNE
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State | IN
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Zip | 46860-1724
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Country | US
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Telephone | 260-420-6500
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOEL BENZ
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Credential |
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Telephone | 260-420-6500
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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 | 0114
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License Number State | IN
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