Healthcare Provider Details

I. General information

NPI: 1679617195
Provider Name (Legal Business Name): CENTER CIVIL TOWNSHIP HENDRICKS COU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 11/12/2023
Certification Date: 11/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W MARION ST
DANVILLE IN
46122-1707
US

IV. Provider business mailing address

PO BOX 50890
INDIANAPOLIS IN
46250-0890
US

V. Phone/Fax

Practice location:
  • Phone: 317-775-6753
  • Fax: 317-849-6632
Mailing address:
  • Phone: 317-849-6628
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0429
License Number StateIN

VIII. Authorized Official

Name: MR. WILLIAM B WRIGHT
Title or Position: TRUSTEE
Credential:
Phone: 317-775-6753