Provider Demographics
NPI:1396829610
Name:CITY OF EVANSVILLE
Entity Type:Organization
Organization Name:CITY OF EVANSVILLE
Other - Org Name:CITY OF EVANSVILLE AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-436-4916
Mailing Address - Street 1:1 NW MARTIN LUTHER KING JR BLVD RM 300
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1833
Mailing Address - Country:US
Mailing Address - Phone:812-436-4916
Mailing Address - Fax:812-436-4926
Practice Address - Street 1:1 NW MARTIN LUTHER KING JR BLVD RM 300
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1833
Practice Address - Country:US
Practice Address - Phone:812-436-4916
Practice Address - Fax:812-436-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55340384OtherMEDICAID
IL=========001OtherMEDICAID
IN985650Medicare ID - Type Unspecified