Provider Demographics
NPI:1942424460
Name:CAPON SPRINGS FIRE DEPT, INC
Entity Type:Organization
Organization Name:CAPON SPRINGS FIRE DEPT, INC
Other - Org Name:CAPON SPRINGS VOLUNTEER FIRE & RESCUE CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-874-4337
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:304-521-1576
Practice Address - Street 1:3144 CAPON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAPON SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26823-9998
Practice Address - Country:US
Practice Address - Phone:304-874-4337
Practice Address - Fax:304-874-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWVEMS341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001397440OtherHIGHMARK BLUE SHIELD
WV590014012OtherRAILROAD MEDICARE
WV8001019000Medicaid