Provider Demographics
NPI:1861487134
Name:CRAWFORD COUNTY AUDITOR
Entity Type:Organization
Organization Name:CRAWFORD COUNTY AUDITOR
Other - Org Name:CRAWFORD COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:GOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:812-338-2463
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:ENGLISH
Mailing Address - State:IN
Mailing Address - Zip Code:47118-0336
Mailing Address - Country:US
Mailing Address - Phone:812-338-2463
Mailing Address - Fax:812-338-2463
Practice Address - Street 1:713 EAST STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:ENGLISH
Practice Address - State:IN
Practice Address - Zip Code:47118-0336
Practice Address - Country:US
Practice Address - Phone:812-338-2463
Practice Address - Fax:812-338-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176312OtherANTHEM BC/BS
IN100281700AMedicaid
IN5001404OtherPASSPORT - MA MCO
IN616211800OtherFEDERAL BLACK LUNG PROGRAM
IN590587033OtherRAILROAD MEDICARE - PALMETTO
IN616211800OtherFEDERAL BLACK LUNG PROGRAM