Organization
WOODBURN VOLUNTEER FIRE DEPARTMENT
Active
Organization
WOODBURN VOLUNTEER FIRE DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS LAKE (DIRECTOR)
(260) 632-5218
Entity
Organization
Contact information
Practice address
27731 MAIN ST, WOODBURN, IN 46797
(260) 632-5218
Mailing address
3134 MALLARD COVE LN, FORT WAYNE, IN 46804-2882
(260) 436-9495
(260) 436-7235
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0075
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221364
ANTHEM
IN
Enumeration date
08/07/2006
Last updated
08/22/2020
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