Provider Demographics
NPI:1609299767
Name:WILDCAT TOWNSHIP TIPTON CO
Entity Type:Organization
Organization Name:WILDCAT TOWNSHIP TIPTON CO
Other - Org Name:WILDCAT VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TOWNSHIP TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-775-6753
Mailing Address - Street 1:PO BOX 502250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-7250
Mailing Address - Country:US
Mailing Address - Phone:317-775-6751
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:208 S. INDEPENDENCE ST.
Practice Address - Street 2:
Practice Address - City:WINDFALL
Practice Address - State:IN
Practice Address - Zip Code:46076-0253
Practice Address - Country:US
Practice Address - Phone:765-945-7333
Practice Address - Fax:765-945-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01295604OtherRRMC
IN201220990Medicaid
INP01295604OtherRRMC