Provider Demographics
NPI:1366499071
Name:FOUNTAINTOWN COMMUNITY VOLUNTEER FIRE DEPARTMENT INC.
Entity Type:Organization
Organization Name:FOUNTAINTOWN COMMUNITY VOLUNTEER FIRE DEPARTMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER, BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-775-6753
Mailing Address - Street 1:PO BOX 50890
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-0890
Mailing Address - Country:US
Mailing Address - Phone:317-849-6628
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:141 E BROOKVILLE RD
Practice Address - Street 2:
Practice Address - City:FOUNTAINTOWN
Practice Address - State:IN
Practice Address - Zip Code:46130-9701
Practice Address - Country:US
Practice Address - Phone:317-861-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100290610Medicaid
IN978770Medicare PIN