Organization
MONROE HOSPITAL AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN D HART MD (CEO/MEDICAL DIRECTOR)
(812) 825-0892
Entity
Organization
Contact information
Practice address
4011 S MONROE MEDICAL PARK BLVD, BLOOMINGTON, IN 47403-8000
(812) 825-0904
Mailing address
4011 S MONROE MEDICAL PARK BLVD, BLOOMINGTON, IN 47403-8000
(812) 825-0904
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200921860A
—
IN
01
—
258790
MEDICARE PTAN
IN
Enumeration date
09/21/2008
Last updated
01/23/2009
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