Provider Demographics
NPI:1477188563
Name:TOWN OF WYTHEVILLE
Entity Type:Organization
Organization Name:TOWN OF WYTHEVILLE
Other - Org Name:WYTHEVILLE FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIVISION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LINEBERRY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:276-233-0801
Mailing Address - Street 1:185 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2649
Mailing Address - Country:US
Mailing Address - Phone:276-233-0801
Mailing Address - Fax:
Practice Address - Street 1:185 W SPRING ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2649
Practice Address - Country:US
Practice Address - Phone:276-233-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport