1881693166 NPI number — SHORT GAP VOLUNTEER FIRE COMPANY

Table of content: (NPI 1881693166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881693166 NPI number — SHORT GAP VOLUNTEER FIRE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORT GAP VOLUNTEER FIRE COMPANY
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:
1881693166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2016
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:
800-676-4785
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 KNOBLEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-726-4388
Provider Business Practice Location Address Fax Number:
304-726-4521
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TRENTER
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL CHIEF
Authorized Official Telephone Number:
304-726-4388

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: 323321 . This is a "BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 409664900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590014173 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001705368 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 8005010000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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