Provider Demographics
NPI:1124004619
Name:MIDDLE TWP TRUSTEE
Entity Type:Organization
Organization Name:MIDDLE TWP TRUSTEE
Other - Org Name:PITTSBORO MIDDLE TOWNSHIP FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEUNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-775-6753
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-9163
Mailing Address - Country:US
Mailing Address - Phone:317-892-4386
Mailing Address - Fax:317-852-1119
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167-9163
Practice Address - Country:US
Practice Address - Phone:317-892-5000
Practice Address - Fax:317-852-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0088341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000249808OtherANTHEM
IN200126250AMedicaid
IN345110Medicare ID - Type Unspecified