Healthcare Provider Details

I. General information

NPI: 1205927100
Provider Name (Legal Business Name): MADISON TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7047 E LANDERSDALE RD
CAMBY IN
46113-8511
US

IV. Provider business mailing address

PO BOX 56002
INDIANAPOLIS IN
46256-0002
US

V. Phone/Fax

Practice location:
  • Phone: 317-775-6753
  • Fax:
Mailing address:
  • Phone: 317-775-6753
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0808
License Number StateIN

VIII. Authorized Official

Name: JUAN ALCALA
Title or Position: DIRECTOR
Credential:
Phone: 317-775-6753