Provider Demographics
NPI:1669186599
Name:JASPER COUNTY EMS BOARD
Entity type:Organization
Organization Name:JASPER COUNTY EMS BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:BOARD
Authorized Official - Phone:219-863-1214
Mailing Address - Street 1:2590 W CLARK ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-8892
Mailing Address - Country:US
Mailing Address - Phone:219-866-9452
Mailing Address - Fax:
Practice Address - Street 1:2590 W CLARK ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-8892
Practice Address - Country:US
Practice Address - Phone:219-866-9452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport