MEDICARE: UNITED EMERGENCY MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146D00000X	Personal Emergency Response Attendant
2	343900000X	Non-emergency Medical Transport (VAN)
3	146N00000X	Basic Emergency Medical Technician	1177	IN
4	3416L0300X	Land Ambulance	1177	IN

General Provider Information

NPI Number	:	1154574135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED EMERGENCY MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 591
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-0591
Country	:	US
Telephone Number	:	219-714-4000
Fax Number	:	219-714-4000

Provider Business Practice Location Address
First Line	:	9019 W 133RD AVE
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9200
Country	:	US
Telephone Number	:	219-714-4000
Fax Number	:	219-714-4000

Authorized Official
Title or Position	:	PARTNER / EMS DIRECTOR
Name	:	MR. JASON BLANKINSHIP
Credential	:	NREMT-B
Telephone Number	:	219-714-4000

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	09/07/2011

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