MEDICARE: LETCHER VOLUNTARY FIRE AND RESCUE SQUAD INC

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	1503	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	590009888	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080658200	OTHER	KY	BLACK LUNG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000070207	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1689672651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LETCHER VOLUNTARY FIRE AND RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	PO BOX 89
Second Line	:
City	:	JEREMIAH
State	:	KY
Zip	:	41826-0089
Country	:	US
Telephone Number	:	606-633-8058
Fax Number	:	304-522-4222

Provider Business Practice Location Address
First Line	:	2429 HWY 7 SOUTH
Second Line	:
City	:	JEREMIAH
State	:	KY
Zip	:	41826-9082
Country	:	US
Telephone Number	:	606-633-8058
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	SHAWN GILLEY
Credential	:
Telephone Number	:	606-633-8058

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/21/2023

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Directions to “LETCHER VOLUNTARY FIRE AND RESCUE SQUAD INC ” Practice Location

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