Healthcare Provider Details

I. General information

NPI: 1083613418
Provider Name (Legal Business Name): SOUTHGATE VOLUNTEER FIRE DEPARTMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 ELECTRIC AVE
SOUTHGATE KY
41071-3166
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-1422
  • Fax: 859-781-5598
Mailing address:
  • Phone: 800-676-4785
  • Fax: 304-522-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1539
License Number StateKY

VIII. Authorized Official

Name: ANTHONY KRAMER
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-441-1422