Provider Demographics
NPI:1376587261
Name:NEW HAVEN EMS - EMERGENCY 45
Entity Type:Organization
Organization Name:NEW HAVEN EMS - EMERGENCY 45
Other - Org Name:NEW HAVEN/ADAMS TWP EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LYTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-749-1235
Mailing Address - Street 1:910 HARTZELL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1833
Mailing Address - Country:US
Mailing Address - Phone:260-749-1235
Mailing Address - Fax:260-493-7700
Practice Address - Street 1:910 HARTZELL RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1833
Practice Address - Country:US
Practice Address - Phone:260-749-1235
Practice Address - Fax:260-493-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0216341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100593OtherCSHCS
IN100288310AMedicaid
IN100288310AMedicaid