Organization
SHORT GAP VOLUNTEER FIRE COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN TRENTER (MEDICAL CHIEF)
(304) 726-4388
Entity
Organization
Contact information
Practice address
128 KNOBLEY ROAD, RIDGELEY, WV 26753
(304) 726-4388
(304) 726-4521
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
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001705368
BLUE CROSS
WV
01
—
323321
BLUE CROSS
VA
05
—
409664900
—
MD
01
—
590014173
RAILROAD MEDICARE
WV
05
—
8005010000
—
WV
Enumeration date
07/19/2005
Last updated
05/02/2016
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