1497756043 NPI number — JAY COUNTY GOVERNMENT

Table of content: (NPI 1497756043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497756043 NPI number — JAY COUNTY GOVERNMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAY COUNTY GOVERNMENT
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:
JAY COUNTY EMERGENCY MEDICAL SERVICE
Provider Other Organization Name Type Code:
3
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:
1497756043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 502250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-7250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-775-6751
Provider Business Mailing Address Fax Number:
317-849-6632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 N CREAGOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-726-2311
Provider Business Practice Location Address Fax Number:
260-726-2371
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCFARLAND
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
317-775-6753

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0021 , 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: 107298 . This is a "CHILDRENS SPECIAL HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0506938 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100281680A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 881803 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000201427 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590008516 . This is a "RR RETIREMENT/UHC" identifier . This identifiers is of the category "OTHER".




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