Provider Demographics
NPI:1770795353
Name:TAYLOR COUNTY EMERGENCY SQUAD
Entity type:Organization
Organization Name:TAYLOR COUNTY EMERGENCY SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-265-0904
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354
Mailing Address - Country:US
Mailing Address - Phone:304-265-0904
Mailing Address - Fax:304-265-0906
Practice Address - Street 1:797 GEORGE WASHINGTON HWY.
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354
Practice Address - Country:US
Practice Address - Phone:304-265-0904
Practice Address - Fax:304-265-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV341600000X
341600000X, 3416L0300X
WV54633341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000207283OtherMOUNTAIN STATE BCBS
WV0145530000Medicaid
WV0161950OtherUMWA HEALTH RETIREMENT FU
WV0161950OtherUMWA HEALTH RETIREMENT FUN