Healthcare Provider Details

I. General information

NPI: 1295959799
Provider Name (Legal Business Name): INDEPENDENT FIRE COMPANY NO. 1 OF CHARLES TOWN WEST VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W. SECOND AVENUE
RANSON WV
25438-1071
US

IV. Provider business mailing address

836 4TH AVENUE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-2514
  • Fax: 304-728-6006
Mailing address:
  • Phone: 304-521-1576
  • Fax: 304-521-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberWVEMS
License Number StateWV

VIII. Authorized Official

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