Basic Information
| Provider Information | |||||||||
| NPI: | 1851515373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUGUSTA VOLUNTEER RESCUE SQUAD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045227533 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 16745 NORTHWESTERN PIKE | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | WV | ||||||||
| PostalCode: | 267042605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044968223 | ||||||||
| FaxNumber: | 3048227513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | AYLOR | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 3048227513 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | WV | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 0144881000 | 05 | WV | MEDICAID | 001705383 | 01 | WV | BLUE CROSS | OTHER |