Provider Demographics
NPI:1083795900
Name:KEYSER EMERGENCY MEDICAL SERVICE INC
Entity Type:Organization
Organization Name:KEYSER EMERGENCY MEDICAL SERVICE INC
Other - Org Name:KEYSER EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-788-5314
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-0903
Mailing Address - Country:US
Mailing Address - Phone:304-788-5314
Mailing Address - Fax:
Practice Address - Street 1:236 S WATER ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3013
Practice Address - Country:US
Practice Address - Phone:304-788-5314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV629213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV406590150OtherRAILROAD MEDICARE
MD081428800Medicaid
WV001705369OtherBLUE CROSS BLUE SHIELD WV
WV0145353000Medicaid
WV406590150OtherRAILROAD MEDICARE
WV406590150OtherRAILROAD MEDICARE