Provider Demographics
NPI:1386670701
Name:FRALEY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:FRALEY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-530-0076
Mailing Address - Street 1:106 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1139
Mailing Address - Country:US
Mailing Address - Phone:304-530-0076
Mailing Address - Fax:304-530-2056
Practice Address - Street 1:106 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1139
Practice Address - Country:US
Practice Address - Phone:304-530-0076
Practice Address - Fax:304-530-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145282000Medicaid
WV0145282000Medicaid