Provider Demographics
NPI:1407375827
Name:COUNTY OF GRANT
Entity Type:Organization
Organization Name:COUNTY OF GRANT
Other - Org Name:GRANT COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:681-892-0306
Mailing Address - Street 1:117 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1713
Mailing Address - Country:US
Mailing Address - Phone:681-892-0306
Mailing Address - Fax:304-257-4697
Practice Address - Street 1:117 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1713
Practice Address - Country:US
Practice Address - Phone:681-892-0306
Practice Address - Fax:304-257-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV612063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport