Provider Demographics
NPI:1831428879
Name:CLAY TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Entity type:Organization
Organization Name:CLAY TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-269-8383
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CLAYPOOL
Mailing Address - State:IN
Mailing Address - Zip Code:46510-0071
Mailing Address - Country:US
Mailing Address - Phone:574-566-2545
Mailing Address - Fax:
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAYPOOL
Practice Address - State:IN
Practice Address - Zip Code:46510-0071
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:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0876251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable