Provider Demographics
NPI:1750475281
Name:BERKELEY COUNTY EMERGENCY AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:BERKELEY COUNTY EMERGENCY AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-264-1995
Mailing Address - Street 1:400 WEST STEPHEN STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-264-1995
Mailing Address - Fax:304-267-1753
Practice Address - Street 1:400 WEST STEPHEN STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-264-1995
Practice Address - Fax:304-267-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNO NUMBER GIVEN3416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0144833000Medicaid