Healthcare Provider Details

I. General information

NPI: 1770779860
Provider Name (Legal Business Name): MANCHESTER TOWNSHIP VOLUNTEER FIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10457 STATE ROAD 48
AURORA IN
47001-8928
US

IV. Provider business mailing address

10457 STATE ROAD 48
AURORA IN
47001-8928
US

V. Phone/Fax

Practice location:
  • Phone: 812-926-1334
  • Fax:
Mailing address:
  • Phone: 812-926-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0345
License Number StateIN

VIII. Authorized Official

Name: STEVEN NOEL
Title or Position: BORARD PRESIDENT
Credential:
Phone: 812-926-1334