Provider Demographics
NPI:1164459566
Name:QUINWOOD EMERGENCY AMBULANCE INC
Entity Type:Organization
Organization Name:QUINWOOD EMERGENCY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-438-9252
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:111 MCCLUNG ST
Mailing Address - City:QUINWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25981-0253
Mailing Address - Country:US
Mailing Address - Phone:304-438-9252
Mailing Address - Fax:304-438-7148
Practice Address - Street 1:111 MCCLUNG ST
Practice Address - Street 2:
Practice Address - City:QUINWOOD
Practice Address - State:WV
Practice Address - Zip Code:25981-0253
Practice Address - Country:US
Practice Address - Phone:304-438-9252
Practice Address - Fax:304-438-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31344341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV086795400OtherDEPT OF LABOR
WV001704988OtherMT ST BCBS
WV407590215OtherRAILROAD MEDICARE
WV1141627OtherUMWA
WV0145769000Medicaid
WV086795400OtherDEPT OF LABOR