Provider Demographics
NPI:1457459737
Name:SCOTT COUNTY
Entity Type:Organization
Organization Name:SCOTT COUNTY
Other - Org Name:SCOTT COUNTY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-754-0500
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-0727
Mailing Address - Country:US
Mailing Address - Phone:574-293-3030
Mailing Address - Fax:574-294-1345
Practice Address - Street 1:1468 SCOTT VALLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7795
Practice Address - Country:US
Practice Address - Phone:812-754-0500
Practice Address - Fax:812-754-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08983416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000363633OtherANTHEM
IN200513620AMedicaid
P00345462OtherRRMC PTAN
IN200513620AMedicaid
IN=========001OtherTRICARE