MEDICARE: HAZELWOOD VOLUNTEER FIRE DEPT. INC.

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	3416L0300X	Land Ambulance	0142	IN

General Provider Information

NPI Number	:	1366555856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZELWOOD VOLUNTEER FIRE DEPT. INC.

Provider Business Mailing Address
First Line	:	PO BOX 2915
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46515-2915
Country	:	US
Telephone Number	:	574-293-3030
Fax Number	:	574-294-1345

Provider Business Practice Location Address
First Line	:	10042 S COUNTY ROAD 0
Second Line	:
City	:	CLAYTON
State	:	IN
Zip	:	46118-9207
Country	:	US
Telephone Number	:	317-539-6404
Fax Number	:	317-539-6530

Authorized Official
Title or Position	:	EMS OFFICER
Name	:	KAREN COOPER
Credential	:
Telephone Number	:	317-539-6404

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/22/2020

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