Basic Information
| Provider Information | |||||||||
| NPI: | 1609877273 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CEREDO VOLUNTEER FIRE DEPARTMENT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE. | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006764785 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 B ST. | ||||||||
| Address2: | |||||||||
| City: | CEREDO | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044534898 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | BURLEY | ||||||||
| AuthorizedOfficialFirstName: | CLINTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3044534898 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | NO NUMBER ISSUED | WV | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 0144586000 | 05 | WV | MEDICAID | 0929688 | 05 | OH | MEDICAID | 55690168 | 05 | KY | MEDICAID | 9139652 | 01 | WV | CARELINK | OTHER |