=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114256021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLYMOUTH FIRE & EMS DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2009
-----------------------------------------------------
Last Update Date | 12/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 N CENTER ST
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46563-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-936-2156
-----------------------------------------------------
Fax | 574-936-5256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 N CENTER ST
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46563-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-936-2156
-----------------------------------------------------
Fax | 574-936-5256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | MR. ANDREW J METSKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 574-936-2156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 0169
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------