Provider Demographics
NPI:1265436166
Name:PUTNAM COUNTY OPERATION LIFE, INC.
Entity type:Organization
Organization Name:PUTNAM COUNTY OPERATION LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLAFLIN
Authorized Official - Suffix:
Authorized Official - Credentials:NRP, FP-C
Authorized Official - Phone:765-653-3600
Mailing Address - Street 1:PO BOX 502250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-7250
Mailing Address - Country:US
Mailing Address - Phone:317-849-6628
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:513 S BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2113
Practice Address - Country:US
Practice Address - Phone:765-653-3600
Practice Address - Fax:765-653-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6701163416L0300X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100281580Medicaid
VA228688OtherBLUE CROSS OF VIRGINIA
590568126OtherRAILROAD MEDICARE
000000184970OtherANTHEM INSURANCE