Basic Information
| Provider Information | |||||||||
| NPI: | 1295735033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST LINCOLN COUNTY EMERGENCY MEDICAL SERVICES INC. | ||||||||
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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: | 4520 DANVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | HUSTONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063464519 | ||||||||
| FaxNumber: | 6063460831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | LUSTER | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 6063464519 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1595 | KY | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 000000069754 | 01 | KY | ANTHEM | OTHER | 56004914 | 05 | KY | MEDICAID | 55069058 | 05 | KY | MEDICAID | 1166535 | 01 | KY | PASSPORT | OTHER | 2440045000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 590004755 | 01 | KY | RAILROAD MEDICARE | OTHER |