Provider Demographics
NPI:1003868548
Name:PORTAGE TOWNSHIP PORTER COUNTY
Entity Type:Organization
Organization Name:PORTAGE TOWNSHIP PORTER COUNTY
Other - Org Name:PORTAGE TOWNSHIP AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TOWNSHIP TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-762-1623
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-479-6300
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:398 W 700 N
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385
Practice Address - Country:US
Practice Address - Phone:219-759-3919
Practice Address - Fax:219-759-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0067341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000210160OtherANTHEM
IN100288610Medicaid
IN000000210160OtherANTHEM