MEDICARE: PAW PAW VOLUNTEER FIRE COMPANY

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		WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	406590809	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001705614	OTHER	WV	BLUE CROSS
2	080244200	OTHER	WV	BLACK LUNG
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235138710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAW PAW VOLUNTEER FIRE COMPANY

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	:	44 MOSER AVENUE
Second Line	:
City	:	PAW PAW
State	:	WV
Zip	:	25434
Country	:	US
Telephone Number	:	304-947-7181
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	LOUIS HERRELL
Credential	:
Telephone Number	:	304-947-7181

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/22/2008

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Directions to “PAW PAW VOLUNTEER FIRE COMPANY ” Practice Location

Language	Start Address	Practice Location

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