Provider Demographics
NPI:1740287929
Name:SELLERSBURG VOLUNTEER FIRE DEPARTMENT, INC.
Entity type:Organization
Organization Name:SELLERSBURG VOLUNTEER FIRE DEPARTMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-245-6655
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
Practice Address - Street 1:426 E UTICA ST
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1405
Practice Address - Country:US
Practice Address - Phone:812-246-6655
Practice Address - Fax:812-246-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-04
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN04203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000066545OtherANTHEM BLUE CROSS
KY55340624Medicaid
129917300OtherFEDERAL BLACK LUNG PROGRAM
INN285210OtherHARMONY HEALTH PLAN
IN100290730AMedicaid
KY56008006Medicaid
INN285210OtherHARMONY HEALTH PLAN
129917300OtherFEDERAL BLACK LUNG PROGRAM