Provider Demographics
NPI:1013183144
Name:MASON COUNTY EMERGENCY AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:MASON COUNTY EMERGENCY AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-6134
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:239 JACKSON AVENUE
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550
Practice Address - Country:US
Practice Address - Phone:304-675-6134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV080025800OtherBLACK LUNG
WV590013584OtherRAILROAD MEDICARE
WV001705580OtherBLUE CROSS
WV224644OtherCARELINK
OH2196556Medicaid
WV9000056000Medicaid
OH=========00OtherOH WORKERS COMP
WV224644OtherCARELINK