# PORTAGE TOWNSHIP PORTER COUNTY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Portage Township Ambulance
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003868548
- **Authorized official:** BRENDA CLANCY (TRUSTEE)
- **Authorized official phone:** (219) 762-1623

## Contact information

- **Practice address:** 398 W 700 N, VALPARAISO, IN 46385
- **Practice address phone:** (219) 759-3919
- **Practice address fax:** (219) 759-8068
- **Mailing address:** PO BOX 429, LEWISVILLE, NC 27023-0429
- **Mailing address phone:** (734) 224-4474
- **Mailing address fax:** (336) 791-0196

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 0067 | IN | Yes |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 08/04/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000210160 | ANTHEM | IN |
| 05 | — | 100288610 | — | IN |