1528879087 NPI number — WEST VIRGINIA LIFELINE AMBULANCE SERVICES LLC

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 1528879087 NPI number — WEST VIRGINIA LIFELINE AMBULANCE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST VIRGINIA LIFELINE AMBULANCE SERVICES LLC
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:
Provider Other Organization Name Type Code:
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:
1528879087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKHANNON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26201-0129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-473-8988
Provider Business Mailing Address Fax Number:
304-473-8996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HELEN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HOPE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25880-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-860-8245
Provider Business Practice Location Address Fax Number:
304-473-8996
Provider Enumeration Date:
01/15/2025

Additional Information

Authorized Official

Authorized Official Last Name:
KIRK
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
TYLER
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
304-860-8245

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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