Provider Demographics
NPI:1548599483
Name:WILDCAT TOWNSHIP TRUSTEE
Entity Type:Organization
Organization Name:WILDCAT TOWNSHIP TRUSTEE
Other - Org Name:WILDCAT TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF MEDICAL
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:765-945-7301
Mailing Address - Street 1:208 S. INDEPENDENCE ST.
Mailing Address - Street 2:BOX 253
Mailing Address - City:WINDFALL
Mailing Address - State:IN
Mailing Address - Zip Code:46076
Mailing Address - Country:US
Mailing Address - Phone:765-945-7301
Mailing Address - Fax:765-945-7863
Practice Address - Street 1:208 S. INDEPENDENCE ST.
Practice Address - Street 2:BOX 253
Practice Address - City:WINDFALL
Practice Address - State:IN
Practice Address - Zip Code:46076
Practice Address - Country:US
Practice Address - Phone:765-945-7301
Practice Address - Fax:765-945-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0573343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)