Organization
SHADY GROVE VOLUNTEER FIRE AND RESCUE DEPARTMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DON WRAY (CHIEF)
(540) 890-7484
Entity
Organization
Contact information
Practice address
101 SHADY GROVE DR, THAXTON, VA 24174-2902
(540) 890-7484
(540) 890-2290
Mailing address
836 4TH AVE, HUNTINGTON, WV 25701-1407
(800) 676-4785
(304) 522-4222
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1002
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010142091
—
VA
01
—
178077
BLUE CROSS
VA
01
—
P00208310
RAILROAD MEDICARE
VA
Enumeration date
07/22/2005
Last updated
12/10/2012
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