=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578554416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARAGON VOLUNTEER FIRE COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 09/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E UNION
-----------------------------------------------------
City | PARAGON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-537-9304
-----------------------------------------------------
Fax | 765-537-2993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 225
-----------------------------------------------------
City | PARAGON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46166-0225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-537-9304
-----------------------------------------------------
Fax | 765-537-2993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | MR. DANNY DOTSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-537-9304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------