Provider Demographics
NPI:1073113759
Name:PHYSICIANS AMBULANCE SERVICE OF INDIANA, LLC
Entity type:Organization
Organization Name:PHYSICIANS AMBULANCE SERVICE OF INDIANA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-863-7033
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-0787
Mailing Address - Country:US
Mailing Address - Phone:502-619-8399
Mailing Address - Fax:502-530-0103
Practice Address - Street 1:3305 NICHOL AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3001
Practice Address - Country:US
Practice Address - Phone:502-619-8839
Practice Address - Fax:502-531-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport