Provider Demographics
NPI:1922089663
Name:JAN-CARE AMBULANCE OF NORTH CENTRAL WV INC
Entity Type:Organization
Organization Name:JAN-CARE AMBULANCE OF NORTH CENTRAL WV 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 S FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4606
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
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018379110001Medicaid
WV001705037OtherBCBS OF WV MON CO
OH0193927Medicaid
WV001705036OtherBCBS OF WV MARION CO
WV001707240OtherBSBS WV HARRISON
WV3810008671Medicaid
WV7953361OtherCIGNA MON COUNTY
PA0018379110001Medicaid
WV084005200OtherFEDERAL BLACK LUNG
WV001705035OtherBCBS OF WV HARRISON CO
WV256042OtherCARELINK
WV7194443OtherCIGNA MARION CO
WV9173678OtherCIGNA HARRISON CO
WV74543OtherUNICARE
WV550523041OtherUMWA
WV3810008672Medicaid
WV256042OtherCARELINK
OH0328916Medicaid
WV7953361OtherCIGNA MON COUNTY
OH0328916Medicaid