Provider Demographics
NPI:1538170840
Name:CICERO TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Entity type:Organization
Organization Name:CICERO TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-675-8004
Mailing Address - Street 1:PO BOX 2915
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-2915
Mailing Address - Country:US
Mailing Address - Phone:574-293-3030
Mailing Address - Fax:574-294-1345
Practice Address - Street 1:750 DEVELOPMENT DR
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1072
Practice Address - Country:US
Practice Address - Phone:765-675-8004
Practice Address - Fax:765-675-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200473580AMedicaid
P00399940OtherRRMC PTAN
IN000000333620OtherANTHEM
P00399940OtherRRMC PTAN
IN200473580AMedicaid