1518420876 NPI number — THE TROUTDALE COMMUNITY VOLUNTEER FIRE DEPARTMENT AND RESCUE SQUAD INC

Table of content: (NPI 1518420876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518420876 NPI number — THE TROUTDALE COMMUNITY VOLUNTEER FIRE DEPARTMENT AND RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE TROUTDALE COMMUNITY VOLUNTEER FIRE DEPARTMENT AND RESCUE SQUAD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1518420876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROUTDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24378-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-677-3566
Provider Business Mailing Address Fax Number:
276-677-0205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 RIPSHIN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROUTDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-677-3566
Provider Business Practice Location Address Fax Number:
276-677-0205
Provider Enumeration Date:
04/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ARNOLD
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CAPTAIN
Authorized Official Telephone Number:
276-677-3566

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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