Provider Demographics
NPI:1962569376
Name:CEDAR GROVE VOL FIRE DEPT INC
Entity type:Organization
Organization Name:CEDAR GROVE VOL FIRE DEPT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-545-5001
Mailing Address - Street 1:306 EAST GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:25039
Mailing Address - Country:US
Mailing Address - Phone:304-595-2244
Mailing Address - Fax:
Practice Address - Street 1:306 EAST GEORGE ST
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:WV
Practice Address - Zip Code:25039
Practice Address - Country:US
Practice Address - Phone:304-595-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV=========OtherACORDIA NATIONAL-PEIA
WV001705367OtherBLUE CROSS BLUE SHIELD
WV0145248000Medicaid
WV08092880OtherBLACK LUNG
WV=========OtherAETNA
WV001705367OtherBLUE CROSS BLUE SHIELD