1205828043 NPI number — KENOVA VOLUNTEER FIRE DEPARTMENT

Table of content: (NPI 1205828043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205828043 NPI number — KENOVA VOLUNTEER FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENOVA 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:
1205828043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2012
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:
304-522-7533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOVA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25530-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-453-4153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
304-453-4153

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: 55000301 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080059000 . This is a "BLACK LUNG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0929786 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0145350000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 224282 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 590029255 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 56018559 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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