Provider Demographics
NPI:1134138605
Name:TOWN OF WOLCOTT
Entity Type:Organization
Organization Name:TOWN OF WOLCOTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-279-9255
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:IN
Mailing Address - Zip Code:47995-0038
Mailing Address - Country:US
Mailing Address - Phone:219-279-2216
Mailing Address - Fax:
Practice Address - Street 1:116 S. RANGE ST.
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:IN
Practice Address - Zip Code:47995
Practice Address - Country:US
Practice Address - Phone:219-279-2558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100281820AMedicaid
IN000000208908OtherANTHEM
791590451OtherRAILROAD MEDICARE
978860Medicare ID - Type Unspecified
IN100281820AMedicaid