Provider Demographics
NPI:1811997620
Name:DODDRIDGE COUNTY EMERGENCY SQUAD, INC
Entity type:Organization
Organization Name:DODDRIDGE COUNTY EMERGENCY SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-873-2211
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-0129
Mailing Address - Country:US
Mailing Address - Phone:304-473-8988
Mailing Address - Fax:304-206-3141
Practice Address - Street 1:123 MARIE ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-1131
Practice Address - Country:US
Practice Address - Phone:304-873-2211
Practice Address - Fax:304-873-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV221769OtherCARELINK
WV1054237OtherWC WORKERS COMP
WV001705522OtherBLUE CROSS
WV590013570OtherRAILROAD MEDICARE
WV0145275000Medicaid
WV=========OtherUMWA
WV0145275000Medicaid
WV590013570OtherRAILROAD MEDICARE