1285854307 NPI number — CAPON BRIDGE RESCUE SQUAD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285854307 NPI number — CAPON BRIDGE RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPON BRIDGE RESCUE SQUAD 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:
1285854307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVENUE
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:
304-522-7533
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US ROUTE 50
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPON BRIDGE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26711-0265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-856-3109
Provider Business Practice Location Address Fax Number:
304-856-3109
Provider Enumeration Date:
04/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER RELATIONS SPECIALIST
Authorized Official Telephone Number:
304-522-7533

Provider Taxonomy Codes

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

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

  • Identifier: 083237400 . This is a "BLACK LUNG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 590009398 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001705463 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0144690000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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