Basic Information
| Provider Information | |||||||||
| NPI: | 1366420309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUNLOW VOLUNTEER FIRE DEPARTMENT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045211576 | ||||||||
| FaxNumber: | 3045211768 | ||||||||
| Practice Location | |||||||||
| Address1: | 1383 LEFT FORK DUNLOW BYPASS RD. | ||||||||
| Address2: | |||||||||
| City: | DUNLOW | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043854631 | ||||||||
| FaxNumber: | 3043854706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 12/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | WHEELER | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER RELATIONS SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3043854330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | WVOEMS | WV | N | Transportation Services | Ambulance | 341600000X | WV | N | Transportation Services | Ambulance | 3416L0300X | WVOEMS | WV | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0145821000 | 05 | WV | MEDICAID | 001705895 | 01 | WV | BC | OTHER |