Provider Demographics
NPI:1790862571
Name:SALEM TOWNSHIP DALEVILLE EMERGENCY MEDICAL SERVICES INC.
Entity type:Organization
Organization Name:SALEM TOWNSHIP DALEVILLE EMERGENCY MEDICAL SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-378-5010
Mailing Address - Street 1:PO BOX 56002
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-0002
Mailing Address - Country:US
Mailing Address - Phone:317-849-6628
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:14010 W DALEVILLE RD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:IN
Practice Address - Zip Code:47334-9139
Practice Address - Country:US
Practice Address - Phone:317-849-6628
Practice Address - Fax:317-849-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0073341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200349750AMedicaid
IN200349750AMedicaid