Provider Demographics
NPI:1295716900
Name:JAN-CARE AMBULANCE OF FAYETTE COUNTY INC
Entity type:Organization
Organization Name:JAN-CARE AMBULANCE OF FAYETTE 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 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193932Medicaid
WV001705626OtherBCBS OF WV
PA0018379110001Medicaid
WV3810008647Medicaid
WV001705626OtherBCBS OF WV
WV001705626OtherMSBCBS
WV3810008647Medicaid
WV550523041OtherUMWA
WV27634OtherCARELINK
WV590029202OtherRAILROAD MEDICARE
WV27634OtherCARELINK
WV0008600666OtherAETNA
WV9364401Medicare ID - Type Unspecified
WV9364401Medicare ID - Type Unspecified
WV550523041OtherUMWA
WV590029202OtherRAILROAD MEDICARE
PA0018379110001Medicaid
WV084005200OtherFERDERAL BLACK LUNG
WV001705626OtherBCBS OF WV
WV=========OtherCHAMPVA