Provider Demographics
NPI:1639477920
Name:PRIORITY AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:PRIORITY AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:304-573-6904
Mailing Address - Street 1:23047 MIDLAND TRAIL
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:WV
Mailing Address - Zip Code:25938
Mailing Address - Country:US
Mailing Address - Phone:304-658-4200
Mailing Address - Fax:304-652-5941
Practice Address - Street 1:23047 MIDLAND TRAIL
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:WV
Practice Address - Zip Code:25938
Practice Address - Country:US
Practice Address - Phone:304-658-4200
Practice Address - Fax:304-652-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021458Medicaid
Q37122001Medicare PIN