1851515373 NPI number — AUGUSTA VOLUNTEER RESCUE SQUAD INC

Table of content: (NPI 1851515373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851515373 NPI number — AUGUSTA VOLUNTEER RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUGUSTA VOLUNTEER RESCUE SQUAD 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:
1851515373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVENUE
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-522-7533
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16745 NORTHWESTERN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26704-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-496-8223
Provider Business Practice Location Address Fax Number:
304-822-7513
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AYLOR
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
304-822-7513

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , 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: 0144881000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001705383 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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