Healthcare Provider Details

I. General information

NPI: 1336936970
Provider Name (Legal Business Name): WABASH CIVIL TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2899 KLONDIKE RD
WEST LAFAYETTE IN
47906-5207
US

IV. Provider business mailing address

PO BOX 503024
INDIANAPOLIS IN
46250-8024
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-6664
  • Fax:
Mailing address:
  • Phone: 317-849-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL HUFF
Title or Position: DIVISION CHIEF OF EMS
Credential:
Phone: 317-775-6753