Provider Demographics
NPI:1730286170
Name:WEST LIBERTY VOLUNTEER FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:WEST LIBERTY VOLUNTEER FIRE DEPARTMENT INC
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 AVE
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 1:1333 VAN METER WAY
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:WV
Practice Address - Zip Code:26074
Practice Address - Country:US
Practice Address - Phone:304-639-4335
Practice Address - Fax:304-336-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
N6024159OtherHEALTH PLAN OF UPPER
WV0145013000Medicaid
OH0141779Medicaid
001705613OtherMOUNTAIN STATE BCBS
N6024159OtherHEALTH PLAN OF UPPER
N6024159OtherHEALTH PLAN OF UPPER