Healthcare Provider Details

I. General information

NPI: 1154867273
Provider Name (Legal Business Name): WILDERNESS VOLUNTEER FIRE DEPARTMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E MOUNT LOOKOUT RD
MOUNT LOOKOUT WV
26678-9273
US

IV. Provider business mailing address

119 E MOUNT LOOKOUT RD
MOUNT LOOKOUT WV
26678-9273
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-6339
  • Fax: 304-872-7124
Mailing address:
  • Phone: 304-872-6339
  • Fax: 304-872-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES BICKFORD
Title or Position: CHIEF
Credential:
Phone: 304-872-6339