Organization
CITY OF PORTAGE
Active
Other names
Portage Fire Department Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
ROY JOHNSON (EMS CHIEF OF OPERATIONS)
(219) 707-7711
Entity
Organization
Contact information
Practice address
3401 SWANSON RD, PORTAGE, IN 46368-4822
(219) 762-7784
(219) 763-9607
Mailing address
PO BOX 2122, RIVERVIEW, MI 48193-1122
(800) 926-6985
(734) 479-6319
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0066
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000234636
ANTHEM INSURANCE COMP
IN
05
—
100271470A
—
IN
01
—
590164506
PAMETTO RAILROAD MEDICARE
IN
Enumeration date
03/29/2007
Last updated
03/01/2024
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