Healthcare Provider Details

I. General information

NPI: 1477385532
Provider Name (Legal Business Name): FLAT ROCK VOLUNTEER FIRE DEPT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14480 RIPLEY RD
LEON WV
25123-9672
US

IV. Provider business mailing address

14480 RIPLEY RD
LEON WV
25123-9672
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-4610
  • Fax: 304-675-6819
Mailing address:
  • Phone: 304-675-4610
  • Fax: 304-675-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN KELLEY HOLLEY
Title or Position: FIRE CHIEF
Credential:
Phone: 304-377-0184