Healthcare Provider Details

I. General information

NPI: 1366499071
Provider Name (Legal Business Name): FOUNTAINTOWN COMMUNITY VOLUNTEER FIRE DEPARTMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E BROOKVILLE RD
FOUNTAINTOWN IN
46130-9701
US

IV. Provider business mailing address

PO BOX 50890
INDIANAPOLIS IN
46250-0890
US

V. Phone/Fax

Practice location:
  • Phone: 317-861-4540
  • Fax:
Mailing address:
  • Phone: 317-849-6628
  • Fax: 317-849-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: GEORGINA TYNER
Title or Position: TREASURER, BOARD OF DIRECTORS
Credential:
Phone: 317-775-6753