1003913443 NPI number — VALLEY GROVE VOLUNTEER FIRE DEPARTMENT INC

Table of content: (NPI 1003913443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003913443 NPI number — VALLEY GROVE VOLUNTEER FIRE DEPARTMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY GROVE VOLUNTEER FIRE DEPARTMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003913443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY GROVE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-547-0347
Provider Business Mailing Address Fax Number:
304-547-1085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 FIREHOUSE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY GROVE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-547-0347
Provider Business Practice Location Address Fax Number:
304-547-1085
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
304-547-0347

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  027014 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N7431271 . This is a "HEALTH PLAN OF UPPER OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0144562000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001705486 . This is a "MOUNTAIN STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".