Provider Demographics
NPI:1134176514
Name:UPPER LAUREL FIRE & AMBULANCE, INC.
Entity type:Organization
Organization Name:UPPER LAUREL FIRE & AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:304-294-4400
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:JESSE
Mailing Address - State:WV
Mailing Address - Zip Code:24849-0059
Mailing Address - Country:US
Mailing Address - Phone:304-294-4400
Mailing Address - Fax:304-294-4402
Practice Address - Street 1:POPLAR GAP ROAD
Practice Address - Street 2:
Practice Address - City:SABINE
Practice Address - State:WV
Practice Address - Zip Code:25916
Practice Address - Country:US
Practice Address - Phone:304-294-4400
Practice Address - Fax:304-294-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV-001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9361461Medicare PIN