1407221229 NPI number — MOUNT CROSS VOLUNTEER FIRE AND RESCUE DEPARTMENT INC

Table of content: (NPI 1407221229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407221229 NPI number — MOUNT CROSS VOLUNTEER FIRE AND RESCUE DEPARTMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT CROSS VOLUNTEER FIRE AND RESCUE 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:
1407221229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42002-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-744-9600
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4812 MOUNT CROSS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24540-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-797-5535
Provider Business Practice Location Address Fax Number:
434-793-4059
Provider Enumeration Date:
12/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
434-441-1836

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  916 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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