Provider Demographics
NPI:1093712978
Name:CONDO & SON INC.
Entity Type:Organization
Organization Name:CONDO & SON INC.
Other - Org Name:CONDO & SON FUNERAL HOME & AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDO-STILLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-781-2435
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:WILKINSON
Mailing Address - State:IN
Mailing Address - Zip Code:46186-0128
Mailing Address - Country:US
Mailing Address - Phone:765-781-2435
Mailing Address - Fax:765-781-3234
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKINSON
Practice Address - State:IN
Practice Address - Zip Code:46186-9636
Practice Address - Country:US
Practice Address - Phone:765-781-2435
Practice Address - Fax:765-781-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN973400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000198207OtherANTHEM BC/BS
IN000000198207OtherANTHEM BC/BS