Provider Demographics
NPI:1568682680
Name:ANTHONY CREEK VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD
Entity Type:Organization
Organization Name:ANTHONY CREEK VOLUNTEER FIRE DEPARTMENT & 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:304-522-7533
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-522-7533
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:HC 70 BOX N10
Practice Address - Street 2:
Practice Address - City:NEOLA
Practice Address - State:WV
Practice Address - Zip Code:24961
Practice Address - Country:US
Practice Address - Phone:304-536-1636
Practice Address - Fax:304-536-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV EMS341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0144781000Medicaid
WV=========001OtherWV WORKERS COMP
WV9233591Medicare PIN