Organization
CHARLESTOWN VOLUNTEER FIRE DEPT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK GODDLETT (EMS DIRECTOR)
(812) 256-6202
Entity
Organization
Contact information
Practice address
800 PARK ST, CHARLESTOWN, IN 47111-1657
(812) 256-6202
(812) 256-2094
Mailing address
PO BOX 2915, ELKHART, IN 46515-2915
(574) 293-3030
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1015
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368554
ANTHEM
IN
05
—
200508500A
—
IN
Enumeration date
03/19/2007
Last updated
06/17/2008
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