Provider Demographics
NPI:1992990402
Name:WORTHINGTON VOLUNTEER FIRE DEPT INC
Entity type:Organization
Organization Name:WORTHINGTON VOLUNTEER FIRE DEPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-676-4785
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-287-2985
Mailing Address - Fax:304-287-2985
Practice Address - Street 1:130 MEADOWRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:WV
Practice Address - Zip Code:26591
Practice Address - Country:US
Practice Address - Phone:800-676-7478
Practice Address - Fax:304-287-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9372561Medicare PIN