Healthcare Provider Details

I. General information

NPI: 1619906401
Provider Name (Legal Business Name): MONROEVILLE EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S WATER ST
MONROEVILLE IN
46773-9301
US

IV. Provider business mailing address

3134 MALLARD COVE LN
FORT WAYNE IN
46804-2882
US

V. Phone/Fax

Practice location:
  • Phone: 260-623-3316
  • 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 Number0025
License Number StateIN

VIII. Authorized Official

Name: MR. DEAN ROTHGEB
Title or Position: PRESIDENT
Credential:
Phone: 260-623-6861