Provider Demographics
NPI:1689672651
Name:LETCHER VOLUNTARY FIRE AND RESCUE SQUAD INC
Entity Type:Organization
Organization Name:LETCHER VOLUNTARY FIRE AND RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-633-8058
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:JEREMIAH
Mailing Address - State:KY
Mailing Address - Zip Code:41826-0089
Mailing Address - Country:US
Mailing Address - Phone:606-633-8058
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:2429 HWY 7 SOUTH
Practice Address - Street 2:
Practice Address - City:JEREMIAH
Practice Address - State:KY
Practice Address - Zip Code:41826-9082
Practice Address - Country:US
Practice Address - Phone:606-633-8058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080658200OtherBLACK LUNG
KY55067060Medicaid
KY56008055Medicaid
KY590009888OtherRAILROAD MEDICARE
KY000000070207OtherANTHEM
OH=========00OtherOH WORKER S COMP
KY080658200OtherBLACK LUNG
KY=========OtherUMWA
OH=========00OtherOH WORKER S COMP