Healthcare Provider Details

I. General information

NPI: 1497756043
Provider Name (Legal Business Name): JAY COUNTY GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N CREAGOR AVE
PORTLAND IN
47371
US

IV. Provider business mailing address

PO BOX 502250
INDIANAPOLIS IN
46250-7250
US

V. Phone/Fax

Practice location:
  • Phone: 260-726-2311
  • Fax: 260-726-2371
Mailing address:
  • Phone: 317-775-6751
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0021
License Number StateIN

VIII. Authorized Official

Name: JOHN R MCFARLAND
Title or Position: SUPERVISOR
Credential:
Phone: 317-775-6753