Provider Demographics
NPI:1225179864
Name:GREENTOWN VOLUNTEER FIRE COMPANY
Entity Type:Organization
Organization Name:GREENTOWN VOLUNTEER FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRES
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-438-6277
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46936-0335
Mailing Address - Country:US
Mailing Address - Phone:765-628-7750
Mailing Address - Fax:
Practice Address - Street 1:224 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:IN
Practice Address - Zip Code:46936
Practice Address - Country:US
Practice Address - Phone:765-628-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200906690AMedicaid
IN000000365508OtherANTHEM
IN200906690AMedicaid
IN227400Medicare ID - Type Unspecified