Provider Demographics
NPI:1386975787
Name:ANDERSON TOWNSHIP TTEE
Entity type:Organization
Organization Name:ANDERSON TOWNSHIP TTEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-629-2000
Mailing Address - Street 1:214 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILROY
Mailing Address - State:IN
Mailing Address - Zip Code:46156-9405
Mailing Address - Country:US
Mailing Address - Phone:765-629-2000
Mailing Address - Fax:765-629-2000
Practice Address - Street 1:214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILROY
Practice Address - State:IN
Practice Address - Zip Code:46156-9405
Practice Address - Country:US
Practice Address - Phone:765-629-2000
Practice Address - Fax:765-629-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200977550Medicaid
267520Medicare PIN