Provider Demographics
NPI:1174529499
Name:KOKOMO FIRE DEPARTMENT
Entity type:Organization
Organization Name:KOKOMO FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:EMTB-PI
Authorized Official - Phone:765-456-2039
Mailing Address - Street 1:215 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4637
Mailing Address - Country:US
Mailing Address - Phone:765-456-2039
Mailing Address - Fax:765-456-7579
Practice Address - Street 1:215 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4637
Practice Address - Country:US
Practice Address - Phone:765-456-2039
Practice Address - Fax:765-456-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3400203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN220920Medicare ID - Type Unspecified