# FAYETTE MEMORIAL HOSPITAL ASSOC

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

## Provider details

- **NPI number:** 1144289364
- **Authorized official:** RANDALL WHITE (CEO)
- **Authorized official phone:** (765) 827-7987

## Contact information

- **Practice address:** 1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
- **Practice address phone:** (765) 827-8045
- **Mailing address:** 1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
- **Mailing address phone:** (765) 827-8933
- **Mailing address fax:** (765) 827-7863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 0099 | IN | Yes |

## Other

- **Enumeration date:** 03/18/2006
- **Last updated:** 06/02/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200083640A | — | IN |