Provider Demographics
NPI:1528066511
Name:MASON COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Entity type:Organization
Organization Name:MASON COUNTY EMERGENCY AMBULANCE SERVICE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-6134
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:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:911 EMERGENCY DRIVE
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2005
Practice Address - Country:US
Practice Address - Phone:304-675-6134
Practice Address - Fax:304-675-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV EMS341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV080025800OtherBLACK LUNG
WV590013584OtherRAILROAD MEDICARE
WV001705580OtherBLUE CROSS BLUE SHIELD
OH2196556Medicaid
WV9000056000Medicaid
WV9000056000Medicaid
WV9306464Medicare PIN
WV9000056000Medicaid
WV9306463Medicare PIN
WV9306461Medicare PIN