Provider Demographics
NPI:1366423014
Name:JAN-CARE AMBULANCE OF TRI STATE DIVISION INC
Entity type:Organization
Organization Name:JAN-CARE AMBULANCE OF TRI STATE DIVISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-255-2931
Mailing Address - Street 1:PO BOX 2414
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-2414
Mailing Address - Country:US
Mailing Address - Phone:304-255-2931
Mailing Address - Fax:304-255-0222
Practice Address - Street 1:117 S FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4606
Practice Address - Country:US
Practice Address - Phone:304-255-2931
Practice Address - Fax:304-255-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001705599OtherBCBS OF WV
PA1032235860001Medicaid
OH0193886Medicaid
WV3810008674Medicaid
WV550523041OtherUMWA
WV3810008674Medicaid
PA0018379110001Medicaid
WV084005200OtherFEDERAL BLACK LUNG
WV001705599OtherBCBS OF WV
WV7118331OtherAETNA
WV225905OtherCARELINK
WV3810008675Medicaid
PA0018379110001Medicaid
OH0328916Medicaid
WV7118331OtherAETNA
WV3810008675Medicaid
PA0018379110001Medicaid
WV=========OtherHUMANA
WV225905OtherCARELINK
OH0328916Medicaid