MEDICARE: TOWN OF BOURBON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance		IN

General Provider Information

NPI Number	:	1124115613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF BOURBON

Provider Business Mailing Address
First Line	:	PO BOX 2122
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-1122
Country	:	US
Telephone Number	:	574-342-4755
Fax Number	:	574-342-3205

Provider Business Practice Location Address
First Line	:	104 E PARK AVE
Second Line	:
City	:	BOURBON
State	:	IN
Zip	:	46504-1528
Country	:	US
Telephone Number	:	574-342-4755
Fax Number	:	574-342-3205

Authorized Official
Title or Position	:	CLERK-TREASURER
Name	:	MRS. KIMBERLY A BERGER
Credential	:
Telephone Number	:	574-342-4755

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

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1609852466 — MR. JOHN M REICHERT RPH, MPA
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1912964412 — MRS. SHERRY FAYE PYKE RN
Practice Location Address:

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1689613382 — CHESTER LYNN ROGERS M.D.
Practice Location Address:

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1699836486 — TRITON SCHOOL CORPORATION
Practice Location Address:

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1700940764 — DR. STEPHEN F CULLISON D.D.S.
Practice Location Address:

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Directions to “TOWN OF BOURBON ” Practice Location

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