Provider Demographics
NPI:1346249117
Name:NORTHERN GREENBRIER AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:NORTHERN GREENBRIER AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-497-4334
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-0000
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:304-521-1768
Practice Address - Street 1:ROUTE 219 BOX 74
Practice Address - Street 2:
Practice Address - City:RENICK
Practice Address - State:WV
Practice Address - Zip Code:24966-0000
Practice Address - Country:US
Practice Address - Phone:304-497-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145418000Medicaid
WV080247600OtherBLACK LUNG
WV590011733OtherRR MEDICARE
WV224444OtherCARELINK
OH5508079600OtherOH WORKERS COMP
WV001705371OtherBCBS
WV55080796OtherTRICARE
WV5508079600OtherWV WORKERS COMP
WV0145418000Medicaid