MEDICARE: SPENCER COUNTY EMERGENCY AMBULANCE SERVICE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance
2	3416L0300X	Land Ambulance	740164	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	791590753	OTHER		RAILROAD
2	000000181491	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417926353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPENCER COUNTY EMERGENCY AMBULANCE SERVICE, INC

Provider Business Mailing Address
First Line	:	PO BOX 21727
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-0727
Country	:	US
Telephone Number	:	440-605-9117
Fax Number	:	440-442-4443

Provider Business Practice Location Address
First Line	:	701 DALE-BUFFALOVILLE RD
Second Line	:
City	:	DALE
State	:	IN
Zip	:	47523-9056
Country	:	US
Telephone Number	:	812-937-4700
Fax Number	:

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	JANE STOUT
Credential	:
Telephone Number	:	812-937-4700

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	06/12/2024

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