Healthcare Provider Details

I. General information

NPI: 1538170840
Provider Name (Legal Business Name): CICERO TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 DEVELOPMENT DR
TIPTON IN
46072-1072
US

IV. Provider business mailing address

PO BOX 2915
ELKHART IN
46515-2915
US

V. Phone/Fax

Practice location:
  • Phone: 765-675-8004
  • Fax: 765-675-3528
Mailing address:
  • Phone: 574-293-3030
  • Fax: 574-294-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0083
License Number StateIN

VIII. Authorized Official

Name: MICHAEL J. PRATT
Title or Position: CHIEF
Credential:
Phone: 765-675-8004