Healthcare Provider Details

I. General information

NPI: 1992034730
Provider Name (Legal Business Name): INDIAN CREEK TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5357 STATE ROAD 158
BEDFORD IN
47421-8568
US

IV. Provider business mailing address

PO BOX 1303
BEDFORD IN
47421-1303
US

V. Phone/Fax

Practice location:
  • Phone: 812-279-0590
  • Fax:
Mailing address:
  • Phone: 812-279-0590
  • Fax: 812-279-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number470589
License Number StateIN

VIII. Authorized Official

Name: BUFORD S WRIGHT JR.
Title or Position: ASSISTANT CHIEF
Credential:
Phone: 812-275-7613