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NPI Code Detail

MEDICARE: TIPPECANOE EMERGENCY AMBULANCE SERVICE

MEDICARE: TIPPECANOE EMERGENCY AMBULANCE SERVICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13416L0300XLand Ambulance0007IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1791590342OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000000197897OTHERINANTHEM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063497121
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIPPECANOE EMERGENCY AMBULANCE SERVICE
Provider Business Mailing Address
First Line : PO BOX 5477
Second Line :
City : LAFAYETTE
State : IN
Zip : 47903-5477
Country : US
Telephone Number : 765-423-6235
Fax Number :
Provider Business Practice Location Address
First Line : 1501 HARTFORD ST
Second Line :
City : LAFAYETTE
State : IN
Zip : 47904-2134
Country : US
Telephone Number : 765-423-6235
Fax Number : 765-423-6049
Authorized Official
Title or Position : CEO
Name : MR. ALLEN L. BORCK
Credential :
Telephone Number : 765-423-6235
Provider Enumeration Date : 12/13/2005
Last Update Date : 05/29/2008

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Directions to “TIPPECANOE EMERGENCY AMBULANCE SERVICE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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