Provider Demographics
NPI:1417055773
Name:CITY OF WINCHESTER
Entity Type:Organization
Organization Name:CITY OF WINCHESTER
Other - Org Name:WINCHESTER FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-584-4411
Mailing Address - Street 1:113 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-1851
Mailing Address - Country:US
Mailing Address - Phone:765-584-4411
Mailing Address - Fax:765-584-1964
Practice Address - Street 1:113 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-1851
Practice Address - Country:US
Practice Address - Phone:765-584-4411
Practice Address - Fax:765-584-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000374128OtherANTHEM
IN200514570AMedicaid
P00399944OtherRRMC PTAN
IN227500Medicare ID - Type Unspecified