=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538498241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERTON VOLUNTEER FIRE DEPARTMENT INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2009
-----------------------------------------------------
Last Update Date | 12/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5495 S STATE ROAD 1
-----------------------------------------------------
City | CONNERSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47331-9448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-825-3031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5495 S STATE ROAD 1
-----------------------------------------------------
City | CONNERSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47331-9448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-825-3031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | MR. CHAD RICHARD GRONNING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-265-1371
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------