Basic Information
Provider Information | |||||||||
NPI: | 1629033667 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WASHINGTON COUNTY FIRE RESCUE 1 INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 9150 | ||||||||
Address2: |   | ||||||||
City: | PADUCAH | ||||||||
State: | KY | ||||||||
PostalCode: | 420029150 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2707449600 | ||||||||
FaxNumber: | 2707448642 | ||||||||
Practice Location | |||||||||
Address1: | 15222 LEE HIGHWAY | ||||||||
Address2: |   | ||||||||
City: | BRISTOL | ||||||||
State: | VA | ||||||||
PostalCode: | 242024010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2766691411 | ||||||||
FaxNumber: | 2766420200 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/20/2006 | ||||||||
LastUpdateDate: | 06/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HAROSKY | ||||||||
AuthorizedOfficialFirstName: | CHARLES | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 2766691411 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 00699 | VA | N |   | Transportation Services | Ambulance |   | 3416L0300X |   |   | Y |   | Transportation Services | Ambulance | Land Transport |
ID Information
ID | Type | State | Issuer | Description | 1505364 | 05 | TN |   | MEDICAID | 1629033667 | 05 | VA |   | MEDICAID | 710566600 | 01 | VA | DOL - FECA/ BL/ ENERGY | OTHER | P00016071 | 01 | VA | RAILROAD MEDICARE | OTHER |