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General NPI Number Information
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NPI Number | 1255567624
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Entity Type | Organization
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Legal Business Name | JEFFERSON CENTER WHITLEY COUNTY VFD
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Dates
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Enumeration Date | 05/30/2009
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Last Update Date | 05/30/2009
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Provider Practice Location Address
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Address Line | 5090 E 800 S
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City | COLUMBIA CITY
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State | IN
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Zip | 46725-9294
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Country | US
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Telephone | 260-396-2112
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Fax |
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Provider Business Mailing Address
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Address Line | 5090 E 800 S
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City | COLUMBIA CITY
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State | IN
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Zip | 46725-9294
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Country | US
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Telephone | 260-396-2112
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Fax |
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Authorized Official
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Title or Position | ASSISITANT CHIEF
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Name | MR. CHAD ALAN NIX
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Credential | EMT-B
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Telephone | 260-229-2347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 0799
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License Number State | IN
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