Provider Demographics
NPI:1346222502
Name:JAN-CARE AMBULANCE OF RALEIGH COUNTY INC
Entity Type:Organization
Organization Name:JAN-CARE AMBULANCE OF RALEIGH COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-255-2931
Mailing Address - Street 1:PO BOX 2414
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-2414
Mailing Address - Country:US
Mailing Address - Phone:304-255-2931
Mailing Address - Fax:304-255-0222
Practice Address - Street 1:117 SOUTH FAYETTE STREET
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9056
Practice Address - Country:US
Practice Address - Phone:304-255-2931
Practice Address - Fax:304-255-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008649Medicaid
OH1032235680001Medicaid
OH0149686Medicaid
WV000229636OtherBCBS OF WV
WV76518OtherUNICARE
OH0328916Medicaid
WV550523041OtherUMWA
PA0018379110001Medicaid
WV3810008649Medicaid
WV084005200OtherFEDERAL BLACK LUNG
WV3810008649Medicaid
WV76518OtherUNICARE
WV084005200OtherFEDERAL BLACK LUNG
OH0328916Medicaid
WV4853075OtherCIGNA
WV=========OtherCHAMPVA
WV221893OtherCARELINK
WV008600607OtherAETNA
WV=========-ABOtherACCORDIA
OH0328916Medicaid