Healthcare Provider Details

I. General information

NPI: 1386669521
Provider Name (Legal Business Name): WEST SIDE VOLUNTEER FIRE DEPARTMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21045 NANTICOKE RD
BIVALVE MD
21814-2041
US

IV. Provider business mailing address

PO BOX 557
DENTON MD
21629-0557
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-4790
  • Fax: 410-479-4793
Mailing address:
  • Phone: 410-479-4790
  • Fax: 410-479-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier402010300
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: CATHY LYNN CARTER
Title or Position: BILLING AGENT
Credential:
Phone: 41047974790