Provider Demographics
NPI:1144504630
Name:JEFFERSON COUNTY EMERGENCY SERVICES AGENCY
Entity type:Organization
Organization Name:JEFFERSON COUNTY EMERGENCY SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-433-5378
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:304-521-1576
Practice Address - Street 1:419 16TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-5732
Practice Address - Country:US
Practice Address - Phone:304-839-6319
Practice Address - Fax:304-728-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV EMS3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022558Medicaid