Provider Demographics
NPI:1538263942
Name:CITY OF SISTERSVILLE
Entity type:Organization
Organization Name:CITY OF SISTERSVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHADOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-652-2611
Mailing Address - Street 1:EMS
Mailing Address - Street 2:314 S WELLS ST
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1098
Mailing Address - Country:US
Mailing Address - Phone:304-652-2611
Mailing Address - Fax:304-652-1448
Practice Address - Street 1:242 OXFORD ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1029
Practice Address - Country:US
Practice Address - Phone:304-652-2611
Practice Address - Fax:304-652-1448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERSVILLE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-08
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44811341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0002178004Medicaid
511304Medicare ID - Type Unspecified