Provider Demographics
NPI:1780787721
Name:BRUCETON MILL COMMUNITY AMBULANCE, INC.
Entity type:Organization
Organization Name:BRUCETON MILL COMMUNITY AMBULANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-288-3693
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:MABSCOTT
Mailing Address - State:WV
Mailing Address - Zip Code:25871-0911
Mailing Address - Country:US
Mailing Address - Phone:304-253-1059
Mailing Address - Fax:
Practice Address - Street 1:110 UNION STREET
Practice Address - Street 2:
Practice Address - City:BRUCETON MILLS
Practice Address - State:WV
Practice Address - Zip Code:26525-0084
Practice Address - Country:US
Practice Address - Phone:304-288-3693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145231000Medicaid
WV0145231000Medicaid