Healthcare Provider Details

I. General information

NPI: 1992145072
Provider Name (Legal Business Name): AMITY COMMUNITY VOLUNTEER FIRE DEPARTMENT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3274 S 550 E
FRANKLIN IN
46131-8137
US

IV. Provider business mailing address

PO BOX 56002
INDIANAPOLIS IN
46256-0002
US

V. Phone/Fax

Practice location:
  • Phone: 317-738-3452
  • 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 Number0592
License Number StateIN

VIII. Authorized Official

Name: JACKIE A BROCKMAN
Title or Position: FIRE CHIEF
Credential:
Phone: 317-775-6753