Basic Information
| Provider Information | |||||||||
| NPI: | 1255339164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CUTSHIN VOLUNTEER FIRE & RESCUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006764785 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W RESCUE LANE | ||||||||
| Address2: | |||||||||
| City: | YEADDISS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417778637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062794125 | ||||||||
| FaxNumber: | 6062794125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | JOSEPH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 6062794125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 1620 | KY | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 000000070112 | 01 | KY | ANTHEM | OTHER | 590012383 | 01 | KY | RAILROAD MEDICARE | OTHER | 56008220 | 05 | KY | MEDICAID | 55066054 | 05 | KY | MEDICAID | 081068100 | 01 | KY | BLACK LUNG | OTHER |