Provider Demographics
NPI:1720128168
Name:SALEM VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:SALEM VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-782-3333
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-0126
Mailing Address - Country:US
Mailing Address - Phone:304-782-3333
Mailing Address - Fax:304-782-3819
Practice Address - Street 1:60 MILL STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-9402
Practice Address - Country:US
Practice Address - Phone:304-782-3333
Practice Address - Fax:304-782-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV517113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0144991000Medicaid
WV1025862OtherBRICKSTREET-WORKERS COMP
WV70922OtherUNICARE
WV9260151Medicare PIN
WV9371741Medicare PIN