Provider Demographics
NPI:1417926353
Name:SPENCER COUNTY EMERGENCY AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:SPENCER COUNTY EMERGENCY AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-937-4700
Mailing Address - Street 1:PO BOX 21727
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-0727
Mailing Address - Country:US
Mailing Address - Phone:440-605-9117
Mailing Address - Fax:440-442-4443
Practice Address - Street 1:701 DALE-BUFFALOVILLE RD
Practice Address - Street 2:
Practice Address - City:DALE
Practice Address - State:IN
Practice Address - Zip Code:47523-9056
Practice Address - Country:US
Practice Address - Phone:812-937-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7401643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100282240Medicaid
791590753OtherRAILROAD
IN000000181491OtherANTHEM
IN100282240Medicaid