Basic Information
| Provider Information | |||||||||
| NPI: | 1326046228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMERON VOLUNTEER EMERGENCY SQUAD 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: | 69 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | CAMERON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260331113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046862707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | BETH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 3046862707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | WV | N | Transportation Services | Ambulance | 3416L0300X | WV | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 225006 | 01 | WV | CARELINK | OTHER | 550771821 | 01 | OH | ANTHEM | OTHER | 001705582 | 01 | WV | BLUE CROSS | OTHER | 55077182100 | 01 | OH | OH WORKERS COMP | OTHER | 2219987 | 05 | OH | MEDICAID | 550771821 | 01 | WV | WV WORKERS COMPE | OTHER | 550771821001 | 01 | WV | TRICARE | OTHER | 590014171 | 01 | WV | RAILROAD MEDICARE | OTHER | 0145244000 | 05 | WV | MEDICAID |