Provider Demographics
NPI:1780913897
Name:WESTPORT COMMUNITY VOLUNTEER FIRE DEPARTMENT
Entity type:Organization
Organization Name:WESTPORT COMMUNITY VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MADDUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-591-3473
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:302 E BENNETT ST.
Mailing Address - City:WESTPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47283
Mailing Address - Country:US
Mailing Address - Phone:812-591-3473
Mailing Address - Fax:
Practice Address - Street 1:302 E BENNETT ST.
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:IN
Practice Address - Zip Code:47283
Practice Address - Country:US
Practice Address - Phone:812-591-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)