Healthcare Provider Details

I. General information

NPI: 1508022690
Provider Name (Legal Business Name): CRAIG COUNTY - PAINT BANK VOLUNTEER FIRE COMPANY AND RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15998 PAINT BANK ROAD
PAINT BANK VA
24131
US

IV. Provider business mailing address

836 4TH AVENUE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 540-897-5200
  • Fax:
Mailing address:
  • Phone: 304-521-1576
  • Fax: 304-521-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number510
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number510
License Number StateVA

VIII. Authorized Official

Name: MIKE WHEELER
Title or Position: PROVIDER RELATIONS SPECIALIST
Credential:
Phone: 304-521-1576