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General NPI Number Information
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NPI Number | 1720613987
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Entity Type | Organization
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Legal Business Name | JEWELL RIDGE VOLUNTEER FIRE DEPARTMENT
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 13228 DISMAL RIVER ROAD
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City | PILGRIMS KNOB
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State | VA
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Zip | 24634
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Country | US
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Telephone | 276-596-0362
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 197
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City | JEWELL RIDGE
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State | VA
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Zip | 24622-0197
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Country | US
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Telephone | 276-881-8304
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Fax |
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Authorized Official
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Title or Position | CAPTAIN
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Name | RICHARD DOUGLAS ROBERTS
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Credential |
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Telephone | 276-596-0362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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