Provider Demographics
NPI:1033250220
Name:CITY OF CONNERSVILLE
Entity Type:Organization
Organization Name:CITY OF CONNERSVILLE
Other - Org Name:FAYETTE COUNTY FIRST AID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY CLERK TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-825-1271
Mailing Address - Street 1:500 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2046
Mailing Address - Country:US
Mailing Address - Phone:765-825-6706
Mailing Address - Fax:765-827-0858
Practice Address - Street 1:2330 N PARK RD
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2904
Practice Address - Country:US
Practice Address - Phone:765-825-3524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057220A3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000315505OtherANTHEM
IN100282160AMedicaid