Provider Demographics
NPI:1457351249
Name:WESTON LEWIS COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Entity Type:Organization
Organization Name:WESTON LEWIS COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-269-8207
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:304-521-1576
Practice Address - Street 1:155 WEST 2ND ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-1665
Practice Address - Country:US
Practice Address - Phone:304-269-8207
Practice Address - Fax:304-269-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001705357OtherHIGHMARK
WV590029305OtherRR MEDICARE
WV889369OtherBLACK LUNG
WV001705357OtherBLUE CROSS
WV0145596000Medicaid
WV221371OtherCARELINK