Healthcare Provider Details

I. General information

NPI: 1790862571
Provider Name (Legal Business Name): SALEM TOWNSHIP DALEVILLE EMERGENCY MEDICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/23/2015
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: 317-849-6628
  • Fax: 317-849-6632
Mailing address:
  • Phone: 317-849-6628
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0073
License Number StateIN

VIII. Authorized Official

Name: MR. MICHAEL HAISLEY
Title or Position: DIRECTOR
Credential:
Phone: 765-378-5010