Provider Demographics
NPI:1699888180
Name:GREENDALE EMERGENCY RESCUE, INC.
Entity type:Organization
Organization Name:GREENDALE EMERGENCY RESCUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-537-1335
Mailing Address - Street 1:911 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1322
Mailing Address - Country:US
Mailing Address - Phone:812-537-1335
Mailing Address - Fax:812-537-3850
Practice Address - Street 1:911 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-1322
Practice Address - Country:US
Practice Address - Phone:812-537-1335
Practice Address - Fax:812-537-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN03703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00399941OtherRRMC PTAN
IN000000385477OtherANTHEM
IN200802680AMedicaid
IN000000385477OtherANTHEM