Organization
CAPON BRIDGE RESCUE SQUAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE WHEELER (PROVIDER RELATIONS SPECIALIST)
(304) 522-7533
Entity
Organization
Contact information
Practice address
US ROUTE 50, CAPON BRIDGE, WV 26711-0265
(304) 856-3109
(304) 856-3109
Mailing address
836 4TH AVENUE, HUNTINGTON, WV 25701-1407
(304) 522-7533
(304) 522-4222
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
WV EMS
WV
341600000X
Ambulance
Primary
—
WV
Other
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
Enumeration date
04/30/2007
Last updated
08/14/2008
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