Provider Demographics
NPI:1194770859
Name:CILLICOTHE EMERGENCY MEDICINE
Entity type:Organization
Organization Name:CILLICOTHE EMERGENCY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-364-8657
Mailing Address - Street 1:1710 LAFAYETTE RD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1033
Mailing Address - Country:US
Mailing Address - Phone:765-364-8657
Mailing Address - Fax:
Practice Address - Street 1:1710 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1033
Practice Address - Country:US
Practice Address - Phone:765-364-8657
Practice Address - Fax:260-407-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN209200Medicare PIN