Provider Demographics
NPI:1831181353
Name:BRAXTON COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Entity type:Organization
Organization Name:BRAXTON COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:PRIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-765-5361
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:304-521-1576
Mailing Address - Fax:304-521-1576
Practice Address - Street 1:685 DAYS DRIVE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9206
Practice Address - Country:US
Practice Address - Phone:304-765-5361
Practice Address - Fax:304-765-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145123000Medicaid
WV9351221Medicare PIN
WV590010429Medicare PIN