MEDICARE: WAYNE VOLUNTEER FIRE DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance		WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	223386	OTHER	WV	CARELINK

General Provider Information

NPI Number	:	1154321024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE VOLUNTEER FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	836 4TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1407
Country	:	US
Telephone Number	:	800-676-4785
Fax Number	:	304-522-4222

Provider Business Practice Location Address
First Line	:	ROUTE 152
Second Line	:
City	:	WAYNE
State	:	WV
Zip	:	25570
Country	:	US
Telephone Number	:	304-272-5656
Fax Number	:	304-272-3189

Authorized Official
Title or Position	:	CHIEF
Name	:	JERRY MAYNARD
Credential	:
Telephone Number	:	304-272-5656

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	04/20/2008

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Directions to “WAYNE VOLUNTEER FIRE DEPARTMENT ” Practice Location

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