Provider Demographics
NPI:1639347669
Name:FORK RIDGE EMS INC.
Entity type:Organization
Organization Name:FORK RIDGE EMS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-658-5940
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:ANSTED
Mailing Address - State:WV
Mailing Address - Zip Code:25812-0520
Mailing Address - Country:US
Mailing Address - Phone:304-658-5940
Mailing Address - Fax:304-658-5941
Practice Address - Street 1:130 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANSTED
Practice Address - State:WV
Practice Address - Zip Code:25812-0520
Practice Address - Country:US
Practice Address - Phone:304-658-5940
Practice Address - Fax:304-658-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV590014570OtherRAILROAD MEDICARE
WV8002019000Medicaid
WVAMB672OtherHEALTH PLAN OF UPPER OHIO
WV002013053OtherMOUNTAIN STATE BCBS
WVAMB672OtherHEALTH PLAN OF UPPER OHIO