Organization
CONVERSE AMBULANCE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JANE THOMAS (EMS COORDINATOR)
(765) 395-1157
Entity
Organization
Contact information
Practice address
210 N. JEFFERSON ST., CONVERSE, IN 46919
(765) 395-3459
Mailing address
PO BOX 2915, ELKHART, IN 46515-2915
(574) 293-3030
(574) 294-1345
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0103
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000250990
ANTHEM
IN
05
—
200454280A
—
IN
01
—
P00399943
RRMC PTAN
—
Enumeration date
08/11/2006
Last updated
04/22/2008
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