1811997620 NPI number — DODDRIDGE COUNTY EMERGENCY SQUAD, INC

Table of content: (NPI 1811997620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811997620 NPI number — DODDRIDGE COUNTY EMERGENCY SQUAD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DODDRIDGE COUNTY EMERGENCY SQUAD, INC
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:
1811997620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2020
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:
304-206-3141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 MARIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST UNION
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26456-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-873-2211
Provider Business Practice Location Address Fax Number:
304-873-2222
Provider Enumeration Date:
07/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARRON
Authorized Official First Name:
KRISTOPHER
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
304-873-2211

Provider Taxonomy Codes

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

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

  • Identifier: 221769 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1054237 . This is a "WC WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001705522 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 590013570 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0145275000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".