Provider Demographics
NPI:1457816613
Name:FOUNTAIN COUNTY AUDITOR
Entity Type:Organization
Organization Name:FOUNTAIN COUNTY AUDITOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT RN/ HEALTH EDUCATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DISMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-762-3035
Mailing Address - Street 1:113 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:IN
Mailing Address - Zip Code:47918-1832
Mailing Address - Country:US
Mailing Address - Phone:765-762-3035
Mailing Address - Fax:765-762-6520
Practice Address - Street 1:113 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:IN
Practice Address - Zip Code:47918-1832
Practice Address - Country:US
Practice Address - Phone:765-762-3035
Practice Address - Fax:765-762-6520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNTAIN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty