Provider Demographics
NPI:1619970860
Name:TOWN OF ST. JOHN
Entity type:Organization
Organization Name:TOWN OF ST. JOHN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWN MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WISZOWATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-365-6043
Mailing Address - Street 1:10955 W 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8824
Mailing Address - Country:US
Mailing Address - Phone:219-365-6034
Mailing Address - Fax:219-558-2080
Practice Address - Street 1:10955 W 93RD AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8824
Practice Address - Country:US
Practice Address - Phone:219-365-6034
Practice Address - Fax:219-558-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-01-17
Deactivation Date:2022-11-11
Deactivation Code:
Reactivation Date:2022-12-14
Provider Licenses
StateLicense IDTaxonomies
IN05663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200367650AMedicaid
IN590015630Medicare ID - Type UnspecifiedRAILROAD MEDICARE ID#
IN190000Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID