Provider Demographics
NPI:1700897154
Name:TIPPECANOE AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:TIPPECANOE AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:IRONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-498-6484
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:TIPPECANOE
Mailing Address - State:IN
Mailing Address - Zip Code:46570-0044
Mailing Address - Country:US
Mailing Address - Phone:574-498-6634
Mailing Address - Fax:574-498-6634
Practice Address - Street 1:18331 STATE ROAD 331
Practice Address - Street 2:
Practice Address - City:TIPPECANOE
Practice Address - State:IN
Practice Address - Zip Code:46570-0044
Practice Address - Country:US
Practice Address - Phone:574-498-6634
Practice Address - Fax:574-498-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN502483416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN234560Medicare ID - Type Unspecified