Provider Demographics
NPI:1265666382
Name:MONON VOLUNTEER FIRE DEPT INC
Entity Type:Organization
Organization Name:MONON VOLUNTEER FIRE DEPT INC
Other - Org Name:MONON FIRST RESPONSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR/ CAPT.
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:EMT/ FIRE FIGHTER
Authorized Official - Phone:219-253-8355
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:MONON
Mailing Address - State:IN
Mailing Address - Zip Code:47959-0021
Mailing Address - Country:US
Mailing Address - Phone:219-253-8355
Mailing Address - Fax:
Practice Address - Street 1:103 E THIRD ST
Practice Address - Street 2:
Practice Address - City:MONON
Practice Address - State:IN
Practice Address - Zip Code:47959
Practice Address - Country:US
Practice Address - Phone:219-253-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONON VOLUNTEER FIRE DEPT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0451305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization