Provider Demographics
NPI:1093715872
Name:WETZEL COUNTY EMERGENCY AMBULANCE
Entity Type:Organization
Organization Name:WETZEL COUNTY EMERGENCY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-5931
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:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:20 EMERGENCY SERVICE LN
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1152
Practice Address - Country:US
Practice Address - Phone:304-455-5931
Practice Address - Fax:304-455-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV081132300OtherBLACK LUNG
WV590012567OtherRAILROAD MEDICARE
WV0145310001Medicaid
KY1093715872Medicaid
WV000204272OtherBLUE CROSS BLUE SHIELD
OH0596814Medicaid
MD419401200Medicaid
WV0145310001Medicaid
WV9212495Medicare PIN