Provider Demographics
NPI:1780826446
Name:CLAY TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:CLAY TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Other - Org Name:CLAYPOOL FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-566-2545
Mailing Address - Street 1:101 NORTH MAIN STREET
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:CLAYPOOL
Mailing Address - State:IN
Mailing Address - Zip Code:46510
Mailing Address - Country:US
Mailing Address - Phone:574-566-2545
Mailing Address - Fax:
Practice Address - Street 1:101 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLAYPOOL
Practice Address - State:IN
Practice Address - Zip Code:46510
Practice Address - Country:US
Practice Address - Phone:574-566-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0876305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service