Basic Information
| Provider Information | |||||||||
| NPI: | 1114996196 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RYLAND HEIGHTS AND COMMUNITY VOLUNTEER FIRE DEPT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045227533 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 10041 DECOURSEY PIKE | ||||||||
| Address2: | |||||||||
| City: | RYLAND HEIGHTS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593567970 | ||||||||
| FaxNumber: | 8593567970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | SQUAD CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8593567970 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 1305 | KY | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 000000187253 | 01 | ANTHEM | OTHER | 55059067 | 05 | KY | MEDICAID |