Provider Demographics
NPI:1104823624
Name:CHINCOTEAGUE VOLUNTEER FIRE CO
Entity Type:Organization
Organization Name:CHINCOTEAGUE VOLUNTEER FIRE CO
Other - Org Name:CHINCOTEAGUE AMBULANCE FUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:757-336-6055
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:CHINCOTEAGUE ISLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23336-0331
Mailing Address - Country:US
Mailing Address - Phone:757-336-6055
Mailing Address - Fax:757-336-6055
Practice Address - Street 1:4028 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE ISLAND
Practice Address - State:VA
Practice Address - Zip Code:23336-2402
Practice Address - Country:US
Practice Address - Phone:757-336-3138
Practice Address - Fax:757-336-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANONE146L00000X
VA351341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes341600000XTransportation ServicesAmbulance
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190002050Medicare UPIN