Basic Information
| Provider Information | |||||||||
| NPI: | 1649227364 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUCK CREEK TOWNSHIP HANCOCK COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68952 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462680952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178706751 | ||||||||
| FaxNumber: | 3178700499 | ||||||||
| Practice Location | |||||||||
| Address1: | 5809 W AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461409654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173351405 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 05/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRANSON | ||||||||
| AuthorizedOfficialFirstName: | MELVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | TRUSTEE | ||||||||
| AuthorizedOfficialTelephone: | 3178944564 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 200449670 | 05 | IN | MEDICAID |