1922117233 NPI number — JEFFERSON TWP ELKHART CO

Table of content: (NPI 1922117233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922117233 NPI number — JEFFERSON TWP ELKHART CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON TWP ELKHART CO
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:
1922117233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2013
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:
58518 STATE ROAD 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46528-8673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-533-0261
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOWE
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
574-533-0261

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0181 , 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: 590000434 . This is a "RRMC PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200364730A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000211128 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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