Provider Demographics
NPI:1790376663
Name:VANBUREN TOWNSHIP MADISON COUNTY
Entity Type:Organization
Organization Name:VANBUREN TOWNSHIP MADISON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:765-536-2042
Mailing Address - Street 1:813 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:SUMMITVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46070-9717
Mailing Address - Country:US
Mailing Address - Phone:765-536-2042
Mailing Address - Fax:
Practice Address - Street 1:813 E MILL ST
Practice Address - Street 2:
Practice Address - City:SUMMITVILLE
Practice Address - State:IN
Practice Address - Zip Code:46070-9717
Practice Address - Country:US
Practice Address - Phone:765-536-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport