City of Plymouth
Organization Active NPI Land Ambulance · Plymouth, IN
NPI 1487732400 · NPPES record last updated Jul 17, 2024
Key facts
- NPI
- 1487732400
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 0169 (IN)
- Legal business name
- CITY OF PLYMOUTH
- Practice address
- 111 N Center St
Plymouth, IN 46563-2101 - Phone
- (574) 936-8291
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Lynn M Gorski
- Title
- Clerk Treasurer
- Phone
- (574) 936-2124
Corporate family (same tax ID) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081218000303 | IN | Part B Supplier - Ambulance Service Supplier | 9032271408 | Practice locations: Plymouth, IN |
National Provider Directory
- Tax ID family
- Plymouth Fire EMS Department
Locations
124 N Michigan St
Plymouth, IN 46563
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 0169 | IN | Yes |
Addresses
Primary practice location
111 N Center St
Plymouth, IN 46563-2101
Mailing address
124 N Michigan St
P O Box 492
Plymouth, IN 46563-2133
Phone (574) 936-2124
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100282150 | Medicaid | IN |
Other names
- Plymouth Community Ambulance Service
Other providers in Plymouth, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.