Provider Demographics
NPI:1700990322
Name:LAKES OF THE FOUR SEASONS VOLUNTEER FIRE FORCE, INC.
Entity Type:Organization
Organization Name:LAKES OF THE FOUR SEASONS VOLUNTEER FIRE FORCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEEREMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-662-7576
Mailing Address - Street 1:745 W 275 S
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-9712
Mailing Address - Country:US
Mailing Address - Phone:219-662-7576
Mailing Address - Fax:219-662-1281
Practice Address - Street 1:745 W 275 S
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-9712
Practice Address - Country:US
Practice Address - Phone:219-662-7576
Practice Address - Fax:219-662-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0438146L00000X, 146N00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200210910AMedicaid
IN187328OtherBCBS
IN132630Medicare PIN