Basic Information
| Provider Information | |||||||||
| NPI: | 1346249117 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHERN GREENBRIER AMBULANCE SERVICE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257010000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045211576 | ||||||||
| FaxNumber: | 3045211768 | ||||||||
| Practice Location | |||||||||
| Address1: | ROUTE 219 BOX 74 | ||||||||
| Address2: | |||||||||
| City: | RENICK | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249660000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044974334 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | BOGGS | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 3044974334 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 0145418000 | 05 | WV | MEDICAID | 080247600 | 01 | WV | BLACK LUNG | OTHER | 590011733 | 01 | WV | RR MEDICARE | OTHER | 224444 | 01 | WV | CARELINK | OTHER | 5508079600 | 01 | OH | OH WORKERS COMP | OTHER | 001705371 | 01 | WV | BCBS | OTHER | 55080796 | 01 | WV | TRICARE | OTHER | 5508079600 | 01 | WV | WV WORKERS COMP | OTHER |