Provider Demographics
NPI:1164527529
Name:IAEGER AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:IAEGER AMBULANCE SERVICE, INC.
Other - Org Name:IAEGER AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-938-5677
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-0999
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COON BRANCH
Practice Address - Street 2:
Practice Address - City:IAEGER
Practice Address - State:WV
Practice Address - Zip Code:24844
Practice Address - Country:US
Practice Address - Phone:304-938-5677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNO NUMBER ON LICENSE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0144612000Medicaid
WV0144612000Medicaid