Basic Information
| Provider Information | |||||||||
| NPI: | 1700999042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST UNION VOLUNTEER LIFE SQUAD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
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| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045211576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 E SPARKS ST | ||||||||
| Address2: | |||||||||
| City: | WEST UNION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456931036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375443958 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTY | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMS CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 9375443958 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 000000307857 | 01 | OH | ANTHEM | OTHER | 0352130 | 05 | OH | MEDICAID |