Provider Demographics
NPI:1780695072
Name:BROWN CIVIL TOWNSHIP
Entity type:Organization
Organization Name:BROWN CIVIL TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWNSHIP TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-831-1734
Mailing Address - Street 1:471 N SAMUEL MOORE PKWY
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1333
Mailing Address - Country:US
Mailing Address - Phone:317-831-1734
Mailing Address - Fax:317-831-8697
Practice Address - Street 1:471 N SAMUEL MOORE PKWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1333
Practice Address - Country:US
Practice Address - Phone:317-831-1734
Practice Address - Fax:317-831-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00893416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000342677OtherANTHEM
IN100288630AMedicaid
590001396OtherRRMC PTAN
ID=========01OtherTRICARE