1063415685 NPI number — LAPEL STONY CREEK TOWNSHIP AMBULANCE SERVICE

Table of content: (NPI 1063415685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063415685 NPI number — LAPEL STONY CREEK TOWNSHIP AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAPEL STONY CREEK TOWNSHIP AMBULANCE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063415685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 S FORD STREET
Provider Second Line Business Mailing Address:
PO BOX 999
Provider Business Mailing Address City Name:
LAPEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46051-0999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-534-3157
Provider Business Mailing Address Fax Number:
765-534-3158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 S FORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46051-0999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-534-3157
Provider Business Practice Location Address Fax Number:
765-534-3158
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BILLING CLERK
Authorized Official Telephone Number:
765-534-3157

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0049 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000186470 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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