Provider Demographics
NPI:1720287675
Name:WETZEL COUNTY EMERGENCY AMBULANCE
Entity type:Organization
Organization Name:WETZEL COUNTY EMERGENCY AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-5931
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:304-522-7533
Mailing Address - Fax:
Practice Address - Street 1:SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:WV
Practice Address - Zip Code:26419
Practice Address - Country:US
Practice Address - Phone:304-455-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV EMS341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145310004Medicaid
WV081132300OtherBLACK LUNG
WV000222331OtherBLUE CROSS BLUE SHIELD
WV590012564OtherRAILROAD MEDICARE
OH0596814Medicaid
WV000222331OtherBLUE CROSS BLUE SHIELD
WV0145310004Medicaid
WV=========00OtherOHIO WORKERS COMP
WV=========00OtherOHIO WORKERS COMP