Organization
JEFFERSON TWP ELKHART CO
Active
Other names
Jefferson Township Ambulance Service
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN L LOWE (EMS DIRECTOR)
(574) 533-0261
Entity
Organization
Contact information
Practice address
58518 STATE ROAD 15, GOSHEN, IN 46528-8673
(574) 533-0261
Mailing address
PO BOX 727, ELKHART, IN 46515-0727
(574) 293-3030
(574) 294-1345
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0181
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000211128
ANTHEM
IN
05
—
200364730A
—
IN
01
—
590000434
RRMC PTAN
—
Enumeration date
08/30/2006
Last updated
05/10/2013
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