=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972961506
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFERSON & CRAIG TOWNSHIP VOLUNTEER FIRE DEPARTMENT, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2016
-----------------------------------------------------
Last Update Date | 02/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 FERRY ST
-----------------------------------------------------
City | VEVAY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47043-1110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-427-3111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 152
-----------------------------------------------------
City | VEVAY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47043-0152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-427-3111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | CHRISTOPHER SEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-427-3111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1173
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------