Provider Demographics
NPI:1609877273
Name:CEREDO VOLUNTEER FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:CEREDO VOLUNTEER FIRE DEPARTMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-453-4898
Mailing Address - Street 1:836 4TH AVE.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:600 B ST.
Practice Address - Street 2:
Practice Address - City:CEREDO
Practice Address - State:WV
Practice Address - Zip Code:25507
Practice Address - Country:US
Practice Address - Phone:304-453-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNO NUMBER ISSUED341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0144586000Medicaid
OH0929688Medicaid
KY55690168Medicaid
WV9139652OtherCARELINK
OH0929688Medicaid
WV9139652OtherCARELINK
WV=========01OtherWV WORKERS COMP
WV=========01OtherWV WORKERS COMP