Provider Demographics
NPI:1811196769
Name:WETZEL COUNTY EMERGENCY AMBULANCE
Entity type:Organization
Organization Name:WETZEL COUNTY EMERGENCY AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-5931
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:304-522-7533
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 83
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:WV
Practice Address - Zip Code:26055-9716
Practice Address - Country:US
Practice Address - Phone:304-455-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV EMS341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001705439OtherBLUE CROSS BLUE SHIELD
OH0596814Medicaid
WV081132300OtherBLACK LUNG
WV0145310000Medicaid
WV590012566OtherRAILROAD MEDICARE
WV0145310000Medicaid
OH0596814Medicaid
WV9212491Medicare PIN