Provider Demographics
NPI:1104857663
Name:GENERAL AMBULANCE RALEIGH, INC.
Entity Type:Organization
Organization Name:GENERAL AMBULANCE RALEIGH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-658-5940
Mailing Address - Street 1:RR 1 BOX 218
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-9596
Mailing Address - Country:US
Mailing Address - Phone:304-465-8995
Mailing Address - Fax:304-465-1039
Practice Address - Street 1:RR 1 BOX 218
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-9596
Practice Address - Country:US
Practice Address - Phone:304-465-8995
Practice Address - Fax:304-465-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVNON-PAROtherANTHEM
WV0145288002Medicaid
WV=========OtherUMWA
WV0145288002Medicaid
WV=========OtherBRICKSTREET WC
WV9339381Medicare ID - Type UnspecifiedPALMETTO MEDICARE