1518978899 NPI number — AURORA EMERGENCY RESCUE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518978899 NPI number — AURORA EMERGENCY RESCUE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA EMERGENCY RESCUE, INC.
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:
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:
1518978899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 727
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46515-0727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-293-3030
Provider Business Mailing Address Fax Number:
574-294-1345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-926-1865
Provider Business Practice Location Address Fax Number:
812-926-3150
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OPP
Authorized Official First Name:
ED
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD PRESIDENT
Authorized Official Telephone Number:
812-926-1865

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0312 , 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: 000000334818 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200169040A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00171651 . This is a "RRMC PTAN" identifier . This identifiers is of the category "OTHER".




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