=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427032580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOLSOM VOLUNTEER FIRE DEPARTMENT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2005
-----------------------------------------------------
Last Update Date | 04/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28372 SHORTLINE HWY.
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-334-5782
-----------------------------------------------------
Fax | 304-334-6992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28372 SHORTLINE HWY.
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-334-5782
-----------------------------------------------------
Fax | 304-334-6992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING CLERK/TREASURER
-----------------------------------------------------
Name | MRS. CINDY K. GLASSCOCK
-----------------------------------------------------
Credential | PARAMEDIC
-----------------------------------------------------
Telephone | 304-334-5782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | WV EMS
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------