MEDICARE: SOUTHGATE VOLUNTEER FIRE DEPARTMENT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1539	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590009391	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61607801500	OTHER	WV	WV WORKERS COMP
3	000000340543	OTHER	KY	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083613418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHGATE VOLUNTEER FIRE DEPARTMENT INC

Provider Business Mailing Address
First Line	:	836 4TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1407
Country	:	US
Telephone Number	:	800-676-4785
Fax Number	:	304-522-4222

Provider Business Practice Location Address
First Line	:	122 ELECTRIC AVE
Second Line	:
City	:	SOUTHGATE
State	:	KY
Zip	:	41071-3166
Country	:	US
Telephone Number	:	859-441-1422
Fax Number	:	859-781-5598

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANTHONY KRAMER
Credential	:
Telephone Number	:	859-441-1422

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/09/2011

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Directions to “SOUTHGATE VOLUNTEER FIRE DEPARTMENT INC ” Practice Location

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