1720062839 NPI number — CASTLETON VOLUNTEER FIRE DEPT, INC.

Table of content: (NPI 1720062839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720062839 NPI number — CASTLETON VOLUNTEER FIRE DEPT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTLETON VOLUNTEER FIRE DEPT, 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:
1720062839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
973 N. SHADELAND AVENUE
Provider Second Line Business Mailing Address:
# 285
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46219-4809
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:
6260 E 86TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46250-1571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-845-4933
Provider Business Practice Location Address Fax Number:
317-845-4930
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLACKWELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
317-845-4934

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0412 , 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: 000000183639 . This is a "BCBS PROV NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100288510A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590000849 . This is a "RR MEDICARE NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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