1982612750 NPI number — TOWNSHIP OF CONCORD

Table of content: (NPI 1982612750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982612750 NPI number — TOWNSHIP OF CONCORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWNSHIP OF CONCORD
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:
CONCORD TOWNSHIP FIRE DEPARTMENT
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:
1982612750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2804 TOLEDO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46516-5778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-293-6899
Provider Business Mailing Address Fax Number:
574-294-7465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23625 CR 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46516-9193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-875-9644
Provider Business Practice Location Address Fax Number:
574-875-7687
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEEBER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
TOWNSHIP TRUSTEE
Authorized Official Telephone Number:
574-293-6889

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1047 , 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: 000384008 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00337260 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200366950A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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