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General NPI Number Information
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NPI Number | 1700897154
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Entity Type | Organization
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Legal Business Name | TIPPECANOE AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18331 STATE ROAD 331
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City | TIPPECANOE
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State | IN
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Zip | 46570-0044
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Country | US
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Telephone | 574-498-6634
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Fax | 574-498-6634
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Provider Business Mailing Address
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Address Line | PO BOX 44
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City | TIPPECANOE
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State | IN
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Zip | 46570-0044
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Country | US
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Telephone | 574-498-6634
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Fax | 574-498-6634
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL EARL IRONS
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Credential |
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Telephone | 574-498-6484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 50248
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License Number State | IN
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