1144354143 NPI number — BRISTOL FIRE DEPT CORP

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 1144354143 NPI number — BRISTOL FIRE DEPT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRISTOL FIRE DEPT CORP
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:
BRISTOL FIRE DEPT
Provider Other Organization Name Type Code:
5
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:
1144354143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 E ELKHART ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46507-9206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-848-4155
Provider Business Mailing Address Fax Number:
574-848-0459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 E ELKHART ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46507-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-848-4155
Provider Business Practice Location Address Fax Number:
574-848-0459
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEMP
Authorized Official First Name:
FAY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATIVE
Authorized Official Telephone Number:
574-848-4155

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0277 , 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: 100290570A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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