MEDICARE: LIBERTY CIVIL TWP

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

General Provider Information

NPI Number	:	1770306292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY CIVIL TWP

Provider Business Mailing Address
First Line	:	PO BOX 502250
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-7250
Country	:	US
Telephone Number	:	317-849-6628
Fax Number	:	317-849-6632

Provider Business Practice Location Address
First Line	:	111 E KENTUCKY ST
Second Line	:
City	:	CLAYTON
State	:	IN
Zip	:	46118-9482
Country	:	US
Telephone Number	:	317-539-5060
Fax Number	:

Authorized Official
Title or Position	:	EMS CHIEF
Name	:	ALAN MCKAMEY
Credential	:
Telephone Number	:	317-775-6753

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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