Penn Township Ttee

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0833 Issued in IN

Legal business name

PENN TOWNSHIP TTEE

Doing business as

Penn Township Fire Department

Practice address

13960 Jackson Rd
Mishawaka, IN 46544-9523

Phone

(574) 904-5024

Fax

(574) 255-4593

NPI assigned

Sep 14, 2012

Last updated

Mar 20, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Doris J Portolese

Title

Trustee

Phone

(574) 532-6365

Specialties & licenses 1

Addresses

Other names 1

• Penn Township Fire Department Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1568712792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2122",
            "city": "RIVERVIEW",
            "state": "MI",
            "postal_code": "481931122",
            "telephone_number": "734-224-4474",
            "fax_number": "734-479-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13960 JACKSON RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465449523",
            "telephone_number": "574-904-5024",
            "fax_number": "574-255-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN TOWNSHIP TTEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "PORTOLESE",
        "authorized_official_first_name": "DORIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "TRUSTEE",
        "authorized_official_telephone_number": "574-532-6365"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn Township Fire Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria E Pedraza, MSW
• Julie Marie Pelletier, PSYD, HSPP
• Ariana Josefina Pena, MSW
• August Glausel Penaloza Luna
• Penn Harris Madison School Corporation
• Jennifer Anne Pennington, D.O.
• Nini Pennoni, RN
• Victoria Penny
• Brandon Penzenik, MSN, RN, APRN,FNP-BC
• Diana E Perez - Solano, PA-C

• Land Ambulance in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Land Ambulance in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.