Provider Demographics
NPI:1508022690
Name:CRAIG COUNTY - PAINT BANK VOLUNTEER FIRE COMPANY AND RESCUE SQUAD
Entity Type:Organization
Organization Name:CRAIG COUNTY - PAINT BANK VOLUNTEER FIRE COMPANY AND RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-521-1576
Mailing Address - Street 1:836 4TH AVENUE
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:304-521-1576
Mailing Address - Fax:304-521-1768
Practice Address - Street 1:15998 PAINT BANK ROAD
Practice Address - Street 2:
Practice Address - City:PAINT BANK
Practice Address - State:VA
Practice Address - Zip Code:24131
Practice Address - Country:US
Practice Address - Phone:540-897-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA510341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508022690Medicaid
WV3810014404Medicaid
VA1508022690Medicaid