Provider Demographics
NPI:1972551885
Name:SUMMERS COUNTY EMS INC
Entity Type:Organization
Organization Name:SUMMERS COUNTY EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CREWEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-466-0312
Mailing Address - Street 1:266 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951
Mailing Address - Country:US
Mailing Address - Phone:304-466-0312
Mailing Address - Fax:304-466-5206
Practice Address - Street 1:266 MAIN ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2526
Practice Address - Country:US
Practice Address - Phone:304-466-0312
Practice Address - Fax:304-466-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145106000Medicaid
WV0145106000Medicaid