Provider Demographics
NPI:1174375422
Name:TOWN OF CLARKSVILLE
Entity type:Organization
Organization Name:TOWN OF CLARKSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEICH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:812-282-7619
Mailing Address - Street 1:2249 SAM GWIN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-9206
Mailing Address - Country:US
Mailing Address - Phone:812-282-7619
Mailing Address - Fax:
Practice Address - Street 1:2249 SAM GWIN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-9206
Practice Address - Country:US
Practice Address - Phone:812-282-7619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance