MEDICARE: EAST ENTERPRISE VOLUNTEER FIRE DEPARTMENT INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1245699909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST ENTERPRISE VOLUNTEER FIRE DEPARTMENT INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 35
Second Line	:
City	:	EAST ENTERPRISE
State	:	IN
Zip	:	47019-0035
Country	:	US
Telephone Number	:	812-534-2752
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 HIGHWAY 56
Second Line	:
City	:	EAST ENTERPRISE
State	:	IN
Zip	:	47019-0035
Country	:	US
Telephone Number	:	812-534-2752
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKE YOCUM
Credential	:
Telephone Number	:	812-534-2752

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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