Provider Demographics
NPI:1902933682
Name:COATESVILLE VOLUNTEER FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:COATESVILLE VOLUNTEER FIRE DEPARTMENT INC
Other - Org Name:COATESVILLE VOLUNTEER FIRE DEPARTMENT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-775-6753
Mailing Address - Street 1:PO BOX 502250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-7250
Mailing Address - Country:US
Mailing Address - Phone:317-849-6628
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:8098 MAIN ST.
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46121
Practice Address - Country:US
Practice Address - Phone:765-386-2391
Practice Address - Fax:765-386-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN04773416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200046770AMedicaid
INM300033739OtherMEDICARE PTAN
IN176820Medicare ID - Type UnspecifiedPROVIDER NUMBER