Provider Demographics
NPI:1457714826
Name:MANGOHICK VOLUNTEER FIRE DEPARTMENT INC.
Entity Type:Organization
Organization Name:MANGOHICK VOLUNTEER FIRE DEPARTMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-769-4381
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:MANQUIN
Mailing Address - State:VA
Mailing Address - Zip Code:23106-0715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3493 KING WILLIAM RD.
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009
Practice Address - Country:US
Practice Address - Phone:804-994-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTIN