Provider Demographics
NPI:1477680528
Name:HARRISON COUNTY EMERGENCY SQUAD
Entity type:Organization
Organization Name:HARRISON COUNTY EMERGENCY SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-623-6611
Mailing Address - Street 1:660 OAKMOUND RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9798
Mailing Address - Country:US
Mailing Address - Phone:304-623-6611
Mailing Address - Fax:304-623-3046
Practice Address - Street 1:660 OAKMOUND RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9798
Practice Address - Country:US
Practice Address - Phone:304-623-6611
Practice Address - Fax:304-623-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145316000Medicaid
WV000224663OtherMOUNTAIN STATE