1902933682 NPI number — COATESVILLE VOLUNTEER FIRE DEPARTMENT INC

Table of content: (NPI 1902933682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902933682 NPI number — COATESVILLE VOLUNTEER FIRE DEPARTMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COATESVILLE VOLUNTEER FIRE DEPARTMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COATESVILLE VOLUNTEER FIRE DEPARTMENT INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902933682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 502250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-7250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-849-6628
Provider Business Mailing Address Fax Number:
317-849-6632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8098 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COATESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-386-2391
Provider Business Practice Location Address Fax Number:
765-386-7490
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLETT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
EMS COORDINATOR
Authorized Official Telephone Number:
317-775-6753

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0477 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200046770A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: M300033739 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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