MEDICARE: SHEPHERDSTOWN FIRE DEPARTMENT

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

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	222422	OTHER	WV	CARELINK

General Provider Information

NPI Number	:	1598764789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEPHERDSTOWN FIRE DEPARTMENT

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	:	852 MARTINSBURG PIKE
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443
Country	:	US
Telephone Number	:	304-876-2311
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	DOUG PITTINGER
Credential	:
Telephone Number	:	304-876-2311

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/20/2008

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Directions to “SHEPHERDSTOWN FIRE DEPARTMENT ” Practice Location

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