Organization
TIPPECANOE EMERGENCY AMBULANCE SERVICE
Active
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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