Healthcare Provider Details

I. General information

NPI: 1083131981
Provider Name (Legal Business Name): SALEM TOWNSHIP DELAWARE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14010 W DALEVILLE RD
DALEVILLE IN
47334-9139
US

IV. Provider business mailing address

PO BOX 56002
INDIANAPOLIS IN
46256-0002
US

V. Phone/Fax

Practice location:
  • Phone: 765-378-0477
  • Fax:
Mailing address:
  • Phone: 317-775-6751
  • Fax: 317-849-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateIN

VIII. Authorized Official

Name: TODD LEWIS
Title or Position: FIRE CHIEF
Credential:
Phone: 317-775-6753