Healthcare Provider Details

I. General information

NPI: 1609299767
Provider Name (Legal Business Name): WILDCAT TOWNSHIP TIPTON CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S. INDEPENDENCE ST.
WINDFALL IN
46076-0253
US

IV. Provider business mailing address

PO BOX 502250
INDIANAPOLIS IN
46250-7250
US

V. Phone/Fax

Practice location:
  • Phone: 765-945-7333
  • Fax: 765-945-7863
Mailing address:
  • Phone: 317-775-6751
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0573
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MEGAN DWIGANS
Title or Position: EMS CHIEF
Credential:
Phone: 317-775-6753