1942539051 NPI number — FREELANDVILLE VOL. FIRE DEPT.

Table of content: RICHARD JAMES JAKUBIK PSY.D, LCSW (NPI 1265773659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942539051 NPI number — FREELANDVILLE VOL. FIRE DEPT.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREELANDVILLE VOL. FIRE DEPT.
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:
1942539051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13.5 HIGHWAY 159 SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREELANDVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47535-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-328-2222
Provider Business Mailing Address Fax Number:
812-328-2222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13.5 HIGHWAY 159 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREELANDVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47535-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-328-2222
Provider Business Practice Location Address Fax Number:
812-328-2222
Provider Enumeration Date:
12/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
812-881-8475

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , 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)