Provider Demographics
NPI:1780717462
Name:TOWN OF MERRILLVILLE EMS
Entity type:Organization
Organization Name:TOWN OF MERRILLVILLE EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWN OF MERRILLVILLE CLERK-TREASURE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-769-3699
Mailing Address - Street 1:7820 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5557
Mailing Address - Country:US
Mailing Address - Phone:219-769-3699
Mailing Address - Fax:
Practice Address - Street 1:26 W 73RD AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3802
Practice Address - Country:US
Practice Address - Phone:219-769-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0333341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000191002OtherBLUE CROSS BLUE SHIELD
IN985260Medicare ID - Type Unspecified