Provider Demographics
NPI:1992145072
Name:AMITY COMMUNITY VOLUNTEER FIRE DEPARTMENT INCORPORATED
Entity type:Organization
Organization Name:AMITY COMMUNITY VOLUNTEER FIRE DEPARTMENT INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-775-6753
Mailing Address - Street 1:PO BOX 56002
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-0002
Mailing Address - Country:US
Mailing Address - Phone:317-849-6628
Mailing Address - Fax:317-849-6632
Practice Address - Street 1:3274 S 550 E
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-8137
Practice Address - Country:US
Practice Address - Phone:317-738-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0592341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance