Provider Demographics
NPI:1609821792
Name:BLOXOM VOLUNTEER FIRE COMPANY
Entity Type:Organization
Organization Name:BLOXOM VOLUNTEER FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-665-4651
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:BLOXOM
Mailing Address - State:VA
Mailing Address - Zip Code:23308-0132
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:15312 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:BLOXOM
Practice Address - State:VA
Practice Address - Zip Code:23308-2820
Practice Address - Country:US
Practice Address - Phone:757-665-5169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA454341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
29304OtherOPTIMA
590014049OtherRR CARE
VA009013601Medicaid
432960OtherBCBS
=========OtherTRI
29304OtherOPTIMA