Healthcare Provider Details

I. General information

NPI: 1316186109
Provider Name (Legal Business Name): MADISON TWP- HOAGLAND FIRE & EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11316 HOAGLAND RD
HOAGLAND IN
46745-9594
US

IV. Provider business mailing address

3134 MALLARD COVE LN
FORT WAYNE IN
46804-2882
US

V. Phone/Fax

Practice location:
  • Phone: 260-639-6895
  • Fax:
Mailing address:
  • Phone: 260-436-9495
  • Fax: 260-436-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateIN

VIII. Authorized Official

Name: PAULINE R SOBONA
Title or Position: BILLING MANAGE
Credential:
Phone: 260-436-9495