Basic Information
| Provider Information | |||||||||
| NPI: | 1578707063 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTON LEWIS COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LEWIS COUNTY EMERGENCY SQUAD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190 | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 264520190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042698207 | ||||||||
| FaxNumber: | 3042698208 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 W 2ND ST | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 264521665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042698207 | ||||||||
| FaxNumber: | 3042698208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARROLL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3042698207 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | WV | Y | Transportation Services | Ambulance |
No ID Information.