MEDICARE: WASHINGTON CIVIL TOWNSHIP

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
1	3416L0300X	Land Ambulance	0337	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000228046	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639188154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON CIVIL TOWNSHIP

Provider Business Mailing Address
First Line	:	1832 W WALLEN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1029
Country	:	US
Telephone Number	:	260-449-3354
Fax Number	:

Provider Business Practice Location Address
First Line	:	1834 W WALLEN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818
Country	:	US
Telephone Number	:	260-449-3671
Fax Number	:	260-449-3672

Authorized Official
Title or Position	:	TRUSTEE
Name	:	ROBERT ARNOLD
Credential	:
Telephone Number	:	260-449-3354

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/30/2018

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Directions to “WASHINGTON CIVIL TOWNSHIP ” Practice Location

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