Healthcare Provider Details

I. General information

NPI: 1336148170
Provider Name (Legal Business Name): DRY FORK SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 16 MAIN ST
WAR WV
24892
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 304-875-2230
  • Fax:
Mailing address:
  • Phone: 800-676-4785
  • Fax: 304-522-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateWV

VIII. Authorized Official

Name: SHEREE HICKS
Title or Position: PRESIDENT
Credential:
Phone: 304-875-2230