Basic Information
| Provider Information | |||||||||
| NPI: | 1730286170 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST LIBERTY 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: | 1333 VAN METER WAY | ||||||||
| Address2: | |||||||||
| City: | WEST LIBERTY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046394335 | ||||||||
| FaxNumber: | 3043363025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | WHEELER | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER RELATIONS SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3045211576 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | N6024159 | 01 | HEALTH PLAN OF UPPER | OTHER | 0145013000 | 05 | WV | MEDICAID | 0141779 | 05 | OH | MEDICAID | 001705613 | 01 | MOUNTAIN STATE BCBS | OTHER |