Provider Demographics
NPI:1689877003
Name:TUCKER COUNTY AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:TUCKER COUNTY AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAVSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-478-2296
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-0129
Mailing Address - Country:US
Mailing Address - Phone:304-473-8988
Mailing Address - Fax:304-206-3141
Practice Address - Street 1:213 FIRST STREET
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-1046
Practice Address - Country:US
Practice Address - Phone:304-478-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWVEMS341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV590029302OtherRR MEDICARE
VA01423631Medicaid
WV0145548000Medicaid
WV002016693OtherBCBS
WV55055932700OtherWV WORKERS COMP
WV000226451OtherBLUE CROSS
WV550559327OtherUMWA
WV550559327OtherTRICARE
WV813343OtherBLACK LUNG
WV9372621Medicare PIN