Provider Demographics
NPI:1659732170
Name:INDIAN MILLS VOLUNTEER FIRE CO NO 1
Entity Type:Organization
Organization Name:INDIAN MILLS VOLUNTEER FIRE CO NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-306-6525
Mailing Address - Street 1:192 A AVE
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2434
Mailing Address - Country:US
Mailing Address - Phone:856-306-6525
Mailing Address - Fax:856-767-3660
Practice Address - Street 1:48 WILLOW GROVE RD
Practice Address - Street 2:
Practice Address - City:SHAMONG
Practice Address - State:NJ
Practice Address - Zip Code:08088-8214
Practice Address - Country:US
Practice Address - Phone:609-268-1114
Practice Address - Fax:609-268-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ102809341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance