P M H Ambulance Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0157 Issued in IN

Legal business name

P M H AMBULANCE INC

Practice address

202 N Indiana St
Roachdale, IN 46172

Phone

(765) 522-1066

Fax

(765) 522-1766

NPI assigned

Oct 25, 2005

Last updated

May 23, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Diana L Poole

Title

Treasurer

Phone

(317) 775-6753

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684800000000",
    "number": "1265422984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50890",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462500890",
            "telephone_number": "317-849-6628",
            "fax_number": "317-849-6632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 N INDIANA ST",
            "city": "ROACHDALE",
            "state": "IN",
            "postal_code": "46172",
            "telephone_number": "765-522-1066",
            "fax_number": "765-522-1766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P M H AMBULANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-25",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "317-775-6753",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Nicole Boninfante
• Randy John Carroll, DDS
• Karen Elizabeth Kimmel, COTA

• Land Ambulance in Roachdale, IN
• Providers in Roachdale, IN by specialty
• Land Ambulance in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.