MEDICARE: STAT AMBULANCE 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)	29203-A	IN
2	341600000X	Ambulance	0541	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000192165	OTHER	IN	ANTHEM
2	590012348	OTHER	IN	PALMETTO GOV'T SERVICES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760501969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAT AMBULANCE INC

Provider Business Mailing Address
First Line	:	1704 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5326
Country	:	US
Telephone Number	:	812-379-9111
Fax Number	:	812-379-9539

Provider Business Practice Location Address
First Line	:	1704 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5326
Country	:	US
Telephone Number	:	812-379-9111
Fax Number	:	812-379-9539

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. ANDREW JASON VEST
Credential	:
Telephone Number	:	812-379-9111

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/05/2011

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Directions to “STAT AMBULANCE INC ” Practice Location

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