Benton County Government
Organization Active NPI Ambulance · Fowler, IN
NPI 1922143239 · NPPES record last updated Dec 18, 2012
Key facts
- NPI
- 1922143239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- Legal business name
- BENTON COUNTY GOVERNMENT
- Practice address
- 604 E 2ND St
Suite C
Fowler, IN 47944 - Phone
- (765) 884-2002
- Fax
- (765) 884-2063
- NPI assigned
- Feb 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Jason Fisher, INDIANA CERTIFIED PA
- Title
- EMS Director
- Phone
- (765) 884-2002
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100301000067 | IN | Part B Supplier - Ambulance Service Supplier | 2961547146 | Practice locations: Boswell, IN; Fowler, IN |
National Provider Directory
Locations
706 E 5th St
Ste 12
Fowler, IN 47944
604 E 2nd St
Fowler, IN 47944
Phone (765) 884-1210
604 E 2nd St
Ste C
Fowler, IN 47944
Phone (765) 491-8183
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | IN | ||
| Ambulance | 341600000X | Yes |
Addresses
Primary practice location
604 E 2ND St
Suite C
Fowler, IN 47944
Mailing address
604 E 2ND St
Suite C
Fowler, IN 47944
Phone (765) 884-2002
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100282190A | Medicaid | IN |
Other names
- Benton County Emergency Ambulance Service
Other providers in Fowler, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.