Provider Demographics
NPI:1578707063
Name:WESTON LEWIS COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Entity Type:Organization
Organization Name:WESTON LEWIS COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Other - Org Name:LEWIS COUNTY EMERGENCY SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-269-8207
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-0190
Mailing Address - Country:US
Mailing Address - Phone:304-269-8207
Mailing Address - Fax:304-269-8208
Practice Address - Street 1:155 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-1665
Practice Address - Country:US
Practice Address - Phone:304-269-8207
Practice Address - Fax:304-269-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance