Provider Demographics
NPI:1548371362
Name:MONONGALIA EMERGENCY MEDICAL SERVICES INC
Entity type:Organization
Organization Name:MONONGALIA EMERGENCY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:
Authorized Official - Last Name:WEYEN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:304-285-2715
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0502
Mailing Address - Country:US
Mailing Address - Phone:304-285-2715
Mailing Address - Fax:304-598-1699
Practice Address - Street 1:801 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3477
Practice Address - Country:US
Practice Address - Phone:304-285-2715
Practice Address - Fax:304-598-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
WV341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145387000Medicaid
590007862Medicare PIN
WV0145387000Medicaid