Provider Demographics
NPI:1205836095
Name:SHAVERS FORK FIRE RESCUE INC
Entity type:Organization
Organization Name:SHAVERS FORK FIRE RESCUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-661-8101
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:SNOWSHOE
Mailing Address - State:WV
Mailing Address - Zip Code:26209-0388
Mailing Address - Country:US
Mailing Address - Phone:304-572-3473
Mailing Address - Fax:304-572-2400
Practice Address - Street 1:150 RESCUE ROAD
Practice Address - Street 2:
Practice Address - City:SNOWSHOE
Practice Address - State:WV
Practice Address - Zip Code:26209
Practice Address - Country:US
Practice Address - Phone:304-572-3473
Practice Address - Fax:304-572-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001776953OtherBLUE CROSS
WV263174OtherCARELINK
WV=========OtherTRICARE
WV3810002251Medicaid
WV=========OtherWV WORKERS COMP
WV=========OtherUMWA
WV9351111Medicare PIN