1568405694 NPI number — TOWN OF WALKERTON

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 1568405694 NPI number — TOWN OF WALKERTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF WALKERTON
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:
WALKERTON LINCOLN FIRE TERRITORY
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:
1568405694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 MICHIGAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALKERTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46574-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-586-3711
Provider Business Mailing Address Fax Number:
574-586-2248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKERTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46574-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-586-3711
Provider Business Practice Location Address Fax Number:
574-586-2248
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILLMAN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
AMBULANCE BILLING CLERK
Authorized Official Telephone Number:
574-586-3711

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0267 , 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: 100282290A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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