Provider Demographics
NPI:1902974413
Name:TOWN OF SHIRLEY
Entity Type:Organization
Organization Name:TOWN OF SHIRLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:EBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-738-6590
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:212 MAIN ST.
Mailing Address - City:SHIRLEY
Mailing Address - State:IN
Mailing Address - Zip Code:47384-0057
Mailing Address - Country:US
Mailing Address - Phone:765-738-6590
Mailing Address - Fax:765-738-6521
Practice Address - Street 1:212 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:IN
Practice Address - Zip Code:47384-0057
Practice Address - Country:US
Practice Address - Phone:765-738-6590
Practice Address - Fax:765-738-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000509764OtherBCBS
IN248210Medicare ID - Type UnspecifiedMEDICARE