MEDICARE: SEALS AMBULANCE SERVICE, INC.

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	343900000X	Non-emergency Medical Transport (VAN)	28771	IN
2	3416L0300X	Land Ambulance	0182	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000182435	OTHER	IN	BCBS-ANTHEM INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174528335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEALS AMBULANCE SERVICE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 660884
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0884
Country	:	US
Telephone Number	:	844-597-4911
Fax Number	:	866-687-2796

Provider Business Practice Location Address
First Line	:	2400 ROOSEVELT AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4214
Country	:	US
Telephone Number	:	844-597-4911
Fax Number	:	866-687-2796

Authorized Official
Title or Position	:	CHIEF REVENUE INTEGRATION OFFICER
Name	:	ROBERT A JEWELL
Credential	:
Telephone Number	:	844-597-4911

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/09/2023

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