Provider Demographics
NPI:1205828043
Name:KENOVA VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:KENOVA VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-453-4153
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-522-7533
Mailing Address - Fax:
Practice Address - Street 1:1600 PINE ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1657
Practice Address - Country:US
Practice Address - Phone:304-453-4153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55000301Medicaid
WV080059000OtherBLACK LUNG
OH0929786Medicaid
WV0145350000Medicaid
WV224282OtherCARELINK
WV590029255OtherRR MEDICARE
KY56018559Medicaid
OH=========00OtherOH WORKERS COMP
WV224282OtherCARELINK
OH0929786Medicaid