Healthcare Provider Details

I. General information

NPI: 1265436166
Provider Name (Legal Business Name): PUTNAM COUNTY OPERATION LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 S BLOOMINGTON ST
GREENCASTLE IN
46135-2113
US

IV. Provider business mailing address

PO BOX 502250
INDIANAPOLIS IN
46250-7250
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-3600
  • Fax: 765-653-5893
Mailing address:
  • Phone: 317-849-6628
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number670116
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number670116
License Number StateIN

VIII. Authorized Official

Name: MR. ERIC J CLAFLIN
Title or Position: EXECUTIVE DIRECTOR
Credential: NRP, FP-C
Phone: 765-653-3600