Provider Demographics
NPI:1174528335
Name:SEALS AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:SEALS AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE INTEGRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-597-4911
Mailing Address - Street 1:PO BOX 660884
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0884
Mailing Address - Country:US
Mailing Address - Phone:844-597-4911
Mailing Address - Fax:866-687-2796
Practice Address - Street 1:2400 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-4214
Practice Address - Country:US
Practice Address - Phone:844-597-4911
Practice Address - Fax:866-687-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28771343900000X
IN01823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182435OtherBCBS-ANTHEM INSURANCE
IN200030170AMedicaid
INP00131498Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN200030170AMedicaid