Provider Demographics
NPI:1346248259
Name:BETHANY VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:BETHANY VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-829-4504
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:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:2619 WEST LIBERTY ROAD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:WV
Practice Address - Zip Code:26032
Practice Address - Country:US
Practice Address - Phone:304-829-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550528612OtherTRICARE
WV0145808000Medicaid
OH55052861200OtherOH WORKERS COMP
WV55052861200OtherWV WORKERS COMP
WV590008637OtherRAILROAD MEDICARE
WV089879600OtherBLACK LUNG
MD405089400Medicaid
WV001705335OtherBLUE CROSS BLUE SHIELD
WV0145808000Medicaid