MEDICARE: GREENE COUNTY AUDITOR

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	3416L0300X	Land Ambulance	0042	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000186277	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1770581266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENE COUNTY AUDITOR

Provider Business Mailing Address
First Line	:	217 E SPRING ST
Second Line	:	SUITE # 5
City	:	BLOOMFIELD
State	:	IN
Zip	:	47424-1589
Country	:	US
Telephone Number	:	812-384-2057
Fax Number	:	812-384-2058

Provider Business Practice Location Address
First Line	:	217 E SPRING ST
Second Line	:	SUITE # 5
City	:	BLOOMFIELD
State	:	IN
Zip	:	47424-1589
Country	:	US
Telephone Number	:	812-384-2057
Fax Number	:	812-384-2058

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DAVID J DOANE
Credential	:
Telephone Number	:	812-384-3176

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/24/2013

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Directions to “GREENE COUNTY AUDITOR ” Practice Location

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