Provider Demographics
NPI:1295872018
Name:CLAY COUNTY AMBULANCE SERVICES
Entity type:Organization
Organization Name:CLAY COUNTY AMBULANCE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-345-2312
Mailing Address - Street 1:601 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1319
Mailing Address - Country:US
Mailing Address - Phone:304-345-2312
Mailing Address - Fax:304-352-5316
Practice Address - Street 1:464 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-587-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001705377OtherBLUE CROSS BLUE SHIELD
WV0145262000Medicaid
WV001705377OtherBLUE CROSS BLUE SHIELD
WV9135481Medicare PIN