Provider Demographics
NPI:1083605356
Name:BROOKE COUNTY AMBULANCE
Entity Type:Organization
Organization Name:BROOKE COUNTY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHWERTFEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-737-1784
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-0268
Mailing Address - Country:US
Mailing Address - Phone:304-737-1784
Mailing Address - Fax:304-737-5121
Practice Address - Street 1:1061 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1344
Practice Address - Country:US
Practice Address - Phone:304-527-3701
Practice Address - Fax:304-737-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV44172OtherCARELINK
OHAMB302OtherUPPER OHIO VALLEY HP
WV0145167000Medicaid
OH0293696OtherOHIO MEDICAID PROVIDER
WV=========OtherADVANTRA
OHAMB302OtherUPPER OHIO VALLEY HP
OHAMB302OtherUPPER OHIO VALLEY HP