1992034730 NPI number — INDIAN CREEK TOWNSHIP VOLUNTEER FIRE DEPARTMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992034730 NPI number — INDIAN CREEK TOWNSHIP VOLUNTEER FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIAN CREEK TOWNSHIP VOLUNTEER FIRE DEPARTMENT
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:
Provider Other Organization Name Type Code:
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:
1992034730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47421-1303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-279-0590
Provider Business Mailing Address Fax Number:
812-279-0590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5357 STATE ROAD 158
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47421-8568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-279-0590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
BUFORD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ASSISTANT CHIEF
Authorized Official Telephone Number:
812-275-7613

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  470589 , 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)