Provider Demographics
NPI:1700867447
Name:JAN-CARE AMBULANCE OF MCDOWELL COUNTY INC
Entity Type:Organization
Organization Name:JAN-CARE AMBULANCE OF MCDOWELL COUNTY 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:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032335910001Medicaid
WV3810008668Medicaid
WV001705560OtherBCBS OF WV
WV084005200OtherFEDERAL BLACK LUNG
OH0328916Medicaid
WV198141OtherCARELINK
WV66807OtherUNICARE
WV001705560OtherBCBS OF WV
PA0018379110001Medicaid
WV9030054000OtherWV MEDICAID VAN/WC
OH0328916Medicaid
WV381008667Medicaid
WV590029202Medicare ID - Type UnspecifiedRAILROAD
KY55001192Medicaid
WV=========OtherHUMANA
WV=========OtherCIGNA
WV66807OtherUNICARE
WV590029202Medicare ID - Type UnspecifiedRAILROAD
WV9365101Medicare ID - Type Unspecified
KY55001192Medicaid