Basic Information
| Provider Information | |||||||||
| NPI: | 1093715872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WETZEL COUNTY EMERGENCY AMBULANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006764785 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 EMERGENCY SERVICE LN | ||||||||
| Address2: | |||||||||
| City: | NEW MARTINSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261551152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044555931 | ||||||||
| FaxNumber: | 3044552824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | COLVIN | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3044555931 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | WV | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 000204272 | 01 | WV | BLUE CROSS BLUE SHIELD | OTHER | 590012567 | 01 | WV | RAILROAD MEDICARE | OTHER | 0596814 | 05 | OH | MEDICAID | 0145310001 | 05 | WV | MEDICAID | 081132300 | 01 | WV | BLACK LUNG | OTHER | 1093715872 | 05 | KY | MEDICAID | 419401200 | 05 | MD | MEDICAID |