Provider Demographics
NPI:1639188154
Name:WASHINGTON CIVIL TOWNSHIP
Entity Type:Organization
Organization Name:WASHINGTON CIVIL TOWNSHIP
Other - Org Name:WASHINGTON TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-449-3354
Mailing Address - Street 1:1832 W WALLEN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-1029
Mailing Address - Country:US
Mailing Address - Phone:260-449-3354
Mailing Address - Fax:
Practice Address - Street 1:1834 W WALLEN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818
Practice Address - Country:US
Practice Address - Phone:260-449-3671
Practice Address - Fax:260-449-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN03373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000228046OtherANTHEM
IN100287810AMedicaid
IN100287810AMedicaid
985590Medicare ID - Type Unspecified