1205825999 NPI number — PUTNAM COUNTY COMMISSION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205825999 NPI number — PUTNAM COUNTY COMMISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUTNAM COUNTY COMMISSION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PUTNAM COUNTY EMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205825999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-521-1576
Provider Business Mailing Address Fax Number:
304-521-1576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 EMERGENCY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-586-0248
Provider Business Practice Location Address Fax Number:
304-586-3049
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARKER
Authorized Official First Name:
KRAIG
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
304-586-0248

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014545200 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000223070 . This is a "BC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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