Healthcare Provider Details

I. General information

NPI: 1720062839
Provider Name (Legal Business Name): CASTLETON VOLUNTEER FIRE DEPT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 E 86TH ST
INDIANAPOLIS IN
46250-1571
US

IV. Provider business mailing address

973 N. SHADELAND AVENUE # 285
INDIANAPOLIS IN
46219-4809
US

V. Phone/Fax

Practice location:
  • Phone: 317-845-4933
  • Fax: 317-845-4930
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 Number0412
License Number StateIN

VIII. Authorized Official

Name: MICHAEL BLACKWELL
Title or Position: FIRE CHIEF
Credential: FIRE CHIEF
Phone: 317-845-4934