Organization
SHADY GROVE VOLUNTEER FIRE AND RESCUE DEPARTMENT INC
Active
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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