Provider Demographics
NPI:1255321550
Name:MULTI TOWNSHIP EMERGENCY MEDICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:MULTI TOWNSHIP EMERGENCY MEDICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DISBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-269-1975
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-0736
Mailing Address - Country:US
Mailing Address - Phone:574-269-1975
Mailing Address - Fax:574-453-4276
Practice Address - Street 1:2304 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3814
Practice Address - Country:US
Practice Address - Phone:574-269-1975
Practice Address - Fax:574-453-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0243341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100282220AMedicaid
791590318OtherRR MEDICARE
979790OtherMEDICARE PTAN
IN979790Medicare PIN