Provider Demographics
NPI:1114256021
Name:PLYMOUTH FIRE & EMS DEPARTMENT
Entity Type:Organization
Organization Name:PLYMOUTH FIRE & EMS DEPARTMENT
Other - Org Name:PLYMOUTH COMMUNITY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:METSKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-936-2156
Mailing Address - Street 1:111 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2101
Mailing Address - Country:US
Mailing Address - Phone:574-936-2156
Mailing Address - Fax:574-936-5256
Practice Address - Street 1:111 N CENTER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2101
Practice Address - Country:US
Practice Address - Phone:574-936-2156
Practice Address - Fax:574-936-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0169341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance