Hymera Emergency Response Team

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0439 Issued in IN

Legal business name

HYMERA EMERGENCY RESPONSE TEAM

Practice address

3134 Mallard Cove LN
Fort Wayne, IN 46804-2882

Phone

(260) 436-9495

Fax

(260) 436-7235

NPI assigned

Aug 5, 2006

Last updated

Aug 22, 2020By 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

Clay Shidler

Title

Director

Phone

(812) 383-5155

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639188378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E JACKSON ST",
            "city": "HYMERA",
            "state": "IN",
            "postal_code": "47855",
            "telephone_number": "260-383-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3134 MALLARD COVE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042882",
            "telephone_number": "260-436-9495",
            "fax_number": "260-436-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HYMERA EMERGENCY RESPONSE TEAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHIDLER",
        "authorized_official_first_name": "CLAY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "812-383-5155"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000203079",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Land Ambulance in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.