MEDICARE: THREE RIVERS AMBULANCE AUTHORITY

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	3416L0300X	Land Ambulance	0114	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0114	OTHER	IN	STATE EMS PROVIDER CERT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861499139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE RIVERS AMBULANCE AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 11724
Second Line	:	525 HAYDEN ST
City	:	FORT WAYNE
State	:	IN
Zip	:	46860-1724
Country	:	US
Telephone Number	:	260-420-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 HAYDEN ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-3550
Country	:	US
Telephone Number	:	260-420-6500
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOEL BENZ
Credential	:
Telephone Number	:	260-420-6500

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/01/2024

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Directions to “THREE RIVERS AMBULANCE AUTHORITY ” Practice Location

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