Provider Demographics
NPI:1366434888
Name:RANDOLPH COUNTY EMS
Entity type:Organization
Organization Name:RANDOLPH COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSITANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-775-6753
Mailing Address - Street 1:PO BOX 503024
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-8024
Mailing Address - Country:US
Mailing Address - Phone:317-849-6628
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:110 E HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-2223
Practice Address - Country:US
Practice Address - Phone:765-584-8055
Practice Address - Fax:765-584-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0272341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300086525Medicaid
IN000000188952OtherANTHEM
IN1002816750AMedicaid