Basic Information
Provider Information | |||||||||
NPI: | 1861408189 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RICHMOND VOLUNTEER FIRE AND RESCUE COMPANY, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 836 4TH AVE | ||||||||
Address2: |   | ||||||||
City: | HUNTINGTON | ||||||||
State: | WV | ||||||||
PostalCode: | 257011407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8006764785 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 7452 ST | ||||||||
Address2: | RTE 152 | ||||||||
City: | RICHMOND | ||||||||
State: | OH | ||||||||
PostalCode: | 439449703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407655390 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2006 | ||||||||
LastUpdateDate: | 01/10/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JEFFERS | ||||||||
AuthorizedOfficialFirstName: | ERIC | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | CAPTAIN | ||||||||
AuthorizedOfficialTelephone: | 7402829766 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X |   |   | Y |   | Transportation Services | Ambulance |   |
ID Information
ID | Type | State | Issuer | Description | 001705127 | 01 | OH | MT STATE | OTHER | 590013933 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000221443 | 01 | OH | ANTHEM | OTHER | 2132132 | 05 | OH |   | MEDICAID |