Provider Demographics
NPI:1467515007
Name:KENT ISLAND VOLUNTEER FIRE DEPARTMENT, INC.
Entity Type:Organization
Organization Name:KENT ISLAND VOLUNTEER FIRE DEPARTMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-643-5457
Mailing Address - Street 1:1610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2790
Mailing Address - Country:US
Mailing Address - Phone:410-643-5457
Mailing Address - Fax:
Practice Address - Street 1:1610 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2790
Practice Address - Country:US
Practice Address - Phone:410-643-5457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTS03OtherCAREFIRST BLUE CROSS
MD401576200Medicaid
MDF642OtherFEDERAL BLUE SHIELD
MD211085OtherHEALTH AMERICA
MDTS03OtherCAREFIRST BLUE CROSS
MD401576200Medicaid