1962569376 NPI number — CEDAR GROVE VOL FIRE DEPT 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 1962569376 NPI number — CEDAR GROVE VOL FIRE DEPT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR GROVE VOL FIRE DEPT 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:
6
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:
1962569376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 EAST GEORGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR GROVE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-595-2244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 EAST GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR GROVE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-595-2244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
304-545-5001

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: ========= . This is a "ACORDIA NATIONAL-PEIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001705367 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0145248000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08092880 . This is a "BLACK LUNG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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