Healthcare Provider Details

I. General information

NPI: 1316185366
Provider Name (Legal Business Name): MORAL TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N. FRONTAGE ROAD
FAIRLAND IN
46126-9481
US

IV. Provider business mailing address

8333 N. FRONTAGE ROAD
FAIRLAND IN
46126-9481
US

V. Phone/Fax

Practice location:
  • Phone: 317-835-2581
  • Fax: 317-849-6632
Mailing address:
  • Phone: 317-835-2581
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0607
License Number StateIN

VIII. Authorized Official

Name: HENRY JOHNSON
Title or Position: TRUSTEE
Credential:
Phone: 317-835-2581