Provider Demographics
NPI:1477676179
Name:SLANESVILLE VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:SLANESVILLE VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-496-8411
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-522-7533
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:RT 29N AND SLANESVILLE PIKE
Practice Address - Street 2:
Practice Address - City:SLANESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25444
Practice Address - Country:US
Practice Address - Phone:304-496-8411
Practice Address - Fax:304-496-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145156000Medicaid
WV=========00OtherWV WORKERS COMP
WV=========00OtherWV WORKERS COMP