Healthcare Provider Details

I. General information

NPI: 1194770859
Provider Name (Legal Business Name): CILLICOTHE EMERGENCY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

IV. Provider business mailing address

1710 LAFAYETTE RD EMERGENCY DEPARTMENT
CRAWFORDSVILLE IN
47933-1033
US

V. Phone/Fax

Practice location:
  • Phone: 765-364-8657
  • Fax: 260-407-8014
Mailing address:
  • Phone: 765-364-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MULVEY
Title or Position: PRESIDENT OWNER
Credential:
Phone: 765-364-8657