Provider Demographics
NPI:1396167482
Name:WASHINGTON COUNTY
Entity type:Organization
Organization Name:WASHINGTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:812-883-2921
Mailing Address - Street 1:601 ANSON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2237
Mailing Address - Country:US
Mailing Address - Phone:812-883-2921
Mailing Address - Fax:812-883-5202
Practice Address - Street 1:601 ANSON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2237
Practice Address - Country:US
Practice Address - Phone:812-883-2921
Practice Address - Fax:812-883-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201219460Medicaid
ININ1775Medicare Oscar/Certification