Provider Demographics
NPI:1487635116
Name:JAN-CARE AMBULANCE OF NICHOLAS CO, INC
Entity Type:Organization
Organization Name:JAN-CARE AMBULANCE OF NICHOLAS CO, 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:2005-11-09
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001705328OtherBCBS OF WV
WV0145332000Medicaid
OH0328916Medicaid
PA1032236200001Medicaid
WV001705328OtherBCBS OF WV
WV084005200OtherFEDERAL BLACK LUNG
WV1020961OtherWC-BRICKSTREET
WV63573OtherUNICARE
WV0145332000Medicaid
WV4526906OtherAETNA
PA0018379110001Medicaid
WV0756063OtherCIGNA
WV1020961OtherWC-BRICKSTREET
WV001705328OtherBCBS OF WV
WV=========OtherHUMANA
WV590029202Medicare ID - Type UnspecifiedRAILROAD
WV=========OtherCHAMPVA
WV0756063OtherCIGNA
WV4526906OtherAETNA
WV63573OtherUNICARE