Basic Information
| Provider Information | |||||||||
| NPI: | 1366499071 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOUNTAINTOWN COMMUNITY VOLUNTEER FIRE DEPARTMENT INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68952 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462680952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178706742 | ||||||||
| FaxNumber: | 3178700499 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 E BROOKVILLE RD | ||||||||
| Address2: | |||||||||
| City: | FOUNTAINTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461309701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178614540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 06/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | TYNER | ||||||||
| AuthorizedOfficialFirstName: | JOANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER, BOARD OF DIRECTORS | ||||||||
| AuthorizedOfficialTelephone: | 3178614540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 100290610 | 05 | IN | MEDICAID |