Provider Demographics
NPI:1548251457
Name:BROWNSBURG CLERK TREASURER
Entity type:Organization
Organization Name:BROWNSBURG CLERK TREASURER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-858-4140
Mailing Address - Street 1:470 EAST NORTHFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2113
Mailing Address - Country:US
Mailing Address - Phone:317-858-4140
Mailing Address - Fax:317-852-1119
Practice Address - Street 1:470 EAST NORTHFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2113
Practice Address - Country:US
Practice Address - Phone:317-858-4140
Practice Address - Fax:317-852-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176614OtherANTHEM PROVIDER NUMBER
IN100286630AMedicaid
IN100286630AMedicaid