Organization
TIPPECANOE EMERGENCY AMBULANCE SERVICE
Active
Other names
TEAS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN L. BORCK (CEO)
(765) 423-6235
Entity
Organization
Contact information
Practice address
1501 HARTFORD ST, LAFAYETTE, IN 47904-2134
(765) 423-6235
(765) 423-6049
Mailing address
PO BOX 5477, LAFAYETTE, IN 47903-5477
(765) 423-6235
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0007
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000197897
ANTHEM
IN
05
—
100281800
—
IN
01
—
791590342
RR MEDICARE
—
Enumeration date
12/13/2005
Last updated
05/29/2008
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