1366499071 NPI number — FOUNTAINTOWN COMMUNITY VOLUNTEER FIRE DEPARTMENT INC.

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 1366499071 NPI number — FOUNTAINTOWN COMMUNITY VOLUNTEER FIRE DEPARTMENT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNTAINTOWN COMMUNITY 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:
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:
1366499071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50890
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:
46250-0890
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:
141 E BROOKVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAINTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46130-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-861-4540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TYNER
Authorized Official First Name:
GEORGINA
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER, BOARD OF DIRECTORS
Authorized Official Telephone Number:
317-775-6753

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100290610 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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