1205836095 NPI number — SHAVERS FORK FIRE RESCUE INC

Table of content: (NPI 1205836095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205836095 NPI number — SHAVERS FORK FIRE RESCUE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAVERS FORK FIRE RESCUE 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:
1205836095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOWSHOE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26209-0388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-572-3473
Provider Business Mailing Address Fax Number:
304-572-2400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 RESCUE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNOWSHOE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-572-3473
Provider Business Practice Location Address Fax Number:
304-572-2400
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF EMS
Authorized Official Telephone Number:
304-661-8101

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001776953 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 263174 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810002251 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "WV WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "UMWA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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