Provider Demographics
NPI:1376588822
Name:CONWAY VILLAGE FIRE DISTRICT
Entity Type:Organization
Organization Name:CONWAY VILLAGE FIRE DISTRICT
Other - Org Name:CONWAY VILLAGE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-447-2681
Mailing Address - Street 1:128 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6139
Mailing Address - Country:US
Mailing Address - Phone:603-447-5470
Mailing Address - Fax:603-447-3271
Practice Address - Street 1:97 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6166
Practice Address - Country:US
Practice Address - Phone:603-447-2681
Practice Address - Fax:603-447-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02293416L0300X
NH291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80009172Medicaid
NH80009172Medicaid