MEDICARE: BLUE RIDGE MT. 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	341600000X	Ambulance	N/A	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	278115	OTHER	VA	BLUE CROSS

General Provider Information

NPI Number	:	1326046194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE MT. VOLUNTEER FIRE CO.

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	:	181 KEYES GAP RD
Second Line	:
City	:	HARPERS FERRY
State	:	WV
Zip	:	25425-4639
Country	:	US
Telephone Number	:	304-728-8006
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	TERESA EDWARDS
Credential	:
Telephone Number	:	304-728-8006

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	04/20/2008

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