Provider Demographics
NPI:1639378581
Name:WETZEL COUNTY EMERGENCY AMBULANCE
Entity type:Organization
Organization Name:WETZEL COUNTY EMERGENCY AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-5931
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:304-522-7533
Mailing Address - Fax:
Practice Address - Street 1:PENNSYLVANIA AVENUE ROUTE 69
Practice Address - Street 2:
Practice Address - City:HUNDRED
Practice Address - State:WV
Practice Address - Zip Code:26575
Practice Address - Country:US
Practice Address - Phone:304-455-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV EMS341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV081132300OtherBLACK LUNG
WV0145310003Medicaid
OH0596814Medicaid
WV590012565OtherRAILROAD MEDICARE
WV001705438OtherBLUE CROSS BLUE SHIELD
WV001705438OtherBLUE CROSS BLUE SHIELD
WV590012565OtherRAILROAD MEDICARE
WV=========002OtherTRICARE
WV=========002OtherTRICARE