MEDICARE: HUNTERTOWN VOLUNTEER FIRE DEPARTMENT

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	0256	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000236327	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1396753075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTERTOWN VOLUNTEER FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	15412 LIMA RD
Second Line	:
City	:	HUNTERTOWN
State	:	IN
Zip	:	46748-9353
Country	:	US
Telephone Number	:	260-449-3696
Fax Number	:

Provider Business Practice Location Address
First Line	:	3134 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2882
Country	:	US
Telephone Number	:	260-436-9495
Fax Number	:	260-436-7235

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	JAMES REID
Credential	:
Telephone Number	:	260-449-3696

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/22/2020

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Directions to “HUNTERTOWN VOLUNTEER FIRE DEPARTMENT ” Practice Location

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