1295959799 NPI number — INDEPENDENT FIRE COMPANY NO. 1 OF CHARLES TOWN WEST VIRGINIA

Table of content: (NPI 1295959799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295959799 NPI number — INDEPENDENT FIRE COMPANY NO. 1 OF CHARLES TOWN WEST VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT FIRE COMPANY NO. 1 OF CHARLES TOWN WEST VIRGINIA
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:
INDEPENDENT FIRE COMPANY NO. 1
Provider Other Organization Name Type Code:
3
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:
1295959799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2012
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:
25701-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-521-1576
Provider Business Mailing Address Fax Number:
304-521-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W. SECOND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25438-1071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-725-2514
Provider Business Practice Location Address Fax Number:
304-728-6006
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER RELATIONS SPECIALIST
Authorized Official Telephone Number:
304-521-1576

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: WVEMS , 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: 0145327000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000236376 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000236376 . This is a "BLUE CROSS WV" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 413426500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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