=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174767875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIAMI TOWNSHIP VOLUNTEER FIRE DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2009
-----------------------------------------------------
Last Update Date | 04/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 CEDAR STREET
-----------------------------------------------------
City | NEW WAVERLY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46961-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-753-4261
-----------------------------------------------------
Fax | 574-516-1014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1
-----------------------------------------------------
City | NEW WAVERLY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46961-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-753-4261
-----------------------------------------------------
Fax | 574-516-1014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MR. JARED WISELEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 574-753-4261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number | 251V00000X
-----------------------------------------------------
License Number State |
-----------------------------------------------------