1477796050 NPI number — BETHANY BEACH VOLUNTEER FIRE CO. INC

Table of content: (NPI 1477796050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477796050 NPI number — BETHANY BEACH VOLUNTEER FIRE CO. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHANY BEACH VOLUNTEER FIRE CO. 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:
1477796050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3348
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304-3348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-280-7040
Provider Business Mailing Address Fax Number:
864-280-7040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 HOLLYWOOD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHANY BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-539-7700
Provider Business Practice Location Address Fax Number:
302-539-6514
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BRACKIN
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS CHIEF
Authorized Official Telephone Number:
302-539-7700

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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