Provider Demographics
NPI:1760510291
Name:CLINTON COUNTY INDIANA
Entity Type:Organization
Organization Name:CLINTON COUNTY INDIANA
Other - Org Name:CLINTON COUNTY E.M.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINTON COUNTY COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-659-6310
Mailing Address - Street 1:170 COURTHOUSE SQ
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-1900
Mailing Address - Country:US
Mailing Address - Phone:765-659-6310
Mailing Address - Fax:765-659-0206
Practice Address - Street 1:170 COURTHOUSE SQ
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-1900
Practice Address - Country:US
Practice Address - Phone:765-659-6310
Practice Address - Fax:765-659-0206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINTON COUNTY INDIANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN791590740OtherAMBULANCE
IN100281910AMedicaid
IN979110Medicare PIN