Healthcare Provider Details

I. General information

NPI: 1366434888
Provider Name (Legal Business Name): RANDOLPH COUNTY EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E HOSPITAL DR
WINCHESTER IN
47394-2223
US

IV. Provider business mailing address

PO BOX 503024
INDIANAPOLIS IN
46250-8024
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-8055
  • Fax: 765-584-1170
Mailing address:
  • Phone: 317-849-6628
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0272
License Number StateIN

VIII. Authorized Official

Name: MR. DALTON BROWN
Title or Position: ASSITANT DIRECTOR
Credential:
Phone: 317-775-6753