Healthcare Provider Details

I. General information

NPI: 1205828043
Provider Name (Legal Business Name): KENOVA VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PINE ST
KENOVA WV
25530-1657
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-4153
  • Fax:
Mailing address:
  • Phone: 304-522-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEVE HENDERSON
Title or Position: CHIEF
Credential:
Phone: 304-453-4153