1154321024 NPI number — WAYNE VOLUNTEER FIRE DEPARTMENT

Table of content: (NPI 1154321024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154321024 NPI number — WAYNE VOLUNTEER FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE VOLUNTEER FIRE DEPARTMENT
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:
1154321024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-676-4785
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 152
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-272-5656
Provider Business Practice Location Address Fax Number:
304-272-3189
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAYNARD
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
304-272-5656

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , 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: 0145574000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0929491 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55000863 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223386 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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