# CAPON BRIDGE RESCUE SQUAD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285854307
- **Authorized official:** MIKE WHEELER (PROVIDER RELATIONS SPECIALIST)
- **Authorized official phone:** (304) 522-7533

## Contact information

- **Practice address:** US ROUTE 50, CAPON BRIDGE, WV 26711-0265
- **Practice address phone:** (304) 856-3109
- **Practice address fax:** (304) 856-3109
- **Mailing address:** 836 4TH AVENUE, HUNTINGTON, WV 25701-1407
- **Mailing address phone:** (304) 522-7533
- **Mailing address fax:** (304) 522-4222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | WV EMS | WV | — |
| 341600000X | Ambulance | — | WV | Yes |

## Other

- **Enumeration date:** 04/30/2007
- **Last updated:** 08/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001705463 | BLUE CROSS/BLUE SHIELD | WV |
| 05 | — | 0144690000 | — | WV |
| 01 | — | 083237400 | BLACK LUNG | WV |
| 01 | — | 590009398 | RAILROAD MEDICARE | WV |