Provider Demographics
NPI:1093342982
Name:BRADLEY PROSPERITY VOL FIRE DEPT
Entity Type:Organization
Organization Name:BRADLEY PROSPERITY VOL FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EMS ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WRISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-923-1239
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-0129
Mailing Address - Country:US
Mailing Address - Phone:304-473-8988
Mailing Address - Fax:304-473-8996
Practice Address - Street 1:5950 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BRADLY
Practice Address - State:WV
Practice Address - Zip Code:25880
Practice Address - Country:US
Practice Address - Phone:304-877-2340
Practice Address - Fax:681-495-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport