Provider Demographics
NPI:1215973888
Name:STATEWIDE TRANSFER AMBULANCE AND RESCUE, INC
Entity type:Organization
Organization Name:STATEWIDE TRANSFER AMBULANCE AND RESCUE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER OF CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-364-1500
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-0444
Mailing Address - Country:US
Mailing Address - Phone:765-364-1500
Mailing Address - Fax:765-364-6981
Practice Address - Street 1:61 E 150 S
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3848
Practice Address - Country:US
Practice Address - Phone:765-364-1500
Practice Address - Fax:765-364-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184933OtherAMBULANCE
IN100288460Medicaid
IN985990Medicare ID - Type UnspecifiedAMBULANCE