Provider Demographics
NPI:1720613987
Name:JEWELL RIDGE VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:JEWELL RIDGE VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-596-0362
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:JEWELL RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24622-0197
Mailing Address - Country:US
Mailing Address - Phone:276-881-8304
Mailing Address - Fax:
Practice Address - Street 1:13228 DISMAL RIVER ROAD
Practice Address - Street 2:
Practice Address - City:PILGRIMS KNOB
Practice Address - State:VA
Practice Address - Zip Code:24634
Practice Address - Country:US
Practice Address - Phone:276-596-0362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance