Provider Demographics
NPI:1861619116
Name:TOWN OF CHESTERFIELD
Entity type:Organization
Organization Name:TOWN OF CHESTERFIELD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-610-8970
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46017-0279
Mailing Address - Country:US
Mailing Address - Phone:765-644-2039
Mailing Address - Fax:765-648-4985
Practice Address - Street 1:207 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:IN
Practice Address - Zip Code:46017-1336
Practice Address - Country:US
Practice Address - Phone:765-378-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN48-0051341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22000000198949OtherANTHEM
IN22000000198949OtherANTHEM