MEDICARE: CHINCOTEAGUE VOLUNTEER FIRE CO

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	146L00000X	Paramedic	NONE	VA
2	341600000X	Ambulance	351	VA

General Provider Information

NPI Number	:	1104823624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINCOTEAGUE VOLUNTEER FIRE CO

Provider Business Mailing Address
First Line	:	PO BOX 331
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-0331
Country	:	US
Telephone Number	:	757-336-6055
Fax Number	:	757-336-6055

Provider Business Practice Location Address
First Line	:	4028 MAIN ST
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-2402
Country	:	US
Telephone Number	:	757-336-3138
Fax Number	:	757-336-6055

Authorized Official
Title or Position	:	AMBULANCE TREASURER
Name	:	MR. JAMES L RUSSELL
Credential	:	EMT-B
Telephone Number	:	757-336-6055

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	09/23/2008

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