Provider Demographics
NPI:1144423385
Name:TRIADELPHIA VOLUNTEER FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:TRIADELPHIA VOLUNTEER FIRE DEPARTMENT INC
Other - Org Name:TRIADELPHIA VFD, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-521-1576
Mailing Address - Street 1:P.O. BOX 15
Mailing Address - Street 2:
Mailing Address - City:TRIADELPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:26059-0015
Mailing Address - Country:US
Mailing Address - Phone:304-547-5010
Mailing Address - Fax:304-547-4293
Practice Address - Street 1:292 NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-0015
Practice Address - Country:US
Practice Address - Phone:304-547-5010
Practice Address - Fax:304-547-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000201449OtherBCBS
WV014485900Medicaid
WV0144859000Medicaid
WV0144859000Medicaid