Greendale Emergency Rescue, Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0370 Issued in IN

Legal business name

GREENDALE EMERGENCY RESCUE, INC.

Practice address

911 Ridge Ave
Greendale, IN 47025-1322

Phone

(812) 537-1335

Fax

(812) 537-3850

NPI assigned

Aug 17, 2006

Last updated

Apr 21, 2017By 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

Tommy Craig

Title

President

Phone

(812) 537-1335

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1699888180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 RIDGE AVE",
            "city": "GREENDALE",
            "state": "IN",
            "postal_code": "470251322",
            "telephone_number": "812-537-1335",
            "fax_number": "812-537-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 RIDGE AVE",
            "city": "GREENDALE",
            "state": "IN",
            "postal_code": "470251322",
            "telephone_number": "812-537-1335",
            "fax_number": "812-537-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENDALE EMERGENCY RESCUE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-537-1335"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200802680A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000385477",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC PTAN",
            "identifier": "P00399941",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Jon Gardner, MD
• Chad T Garman, PA-C
• James J Gibbs, RPH.
• Aleah Pendergraff Gibson, M.D.
• Kylie Goodall, MSW, LCSW
• Eugene Groysman, MD
• Brenda Gullion
• James Hahn, M.D.
• Kayla Mae Hayes, CAPRC2
• Katrina Hegde

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; 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.