Provider Demographics
NPI:1245224880
Name:STAT AMBULANCE SERVICE
Entity Type:Organization
Organization Name:STAT AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-732-9112
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:WV
Mailing Address - Zip Code:25621-0393
Mailing Address - Country:US
Mailing Address - Phone:304-732-9112
Mailing Address - Fax:304-732-8494
Practice Address - Street 1:1 PARK STREET
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:WV
Practice Address - Zip Code:24874
Practice Address - Country:US
Practice Address - Phone:304-732-9112
Practice Address - Fax:304-732-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X, 343900000X
KY16473416L0300X
KY16343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000350799OtherBLUE CROSS BLUE SHIELD
KY55000913Medicaid
WV8005063000Medicaid
WV8005063000Medicaid
KY000000350799OtherBLUE CROSS BLUE SHIELD
KY55000913Medicaid