1750475281 NPI number — BERKELEY COUNTY EMERGENCY AMBULANCE AUTHORITY

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 1750475281 NPI number — BERKELEY COUNTY EMERGENCY AMBULANCE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKELEY COUNTY EMERGENCY AMBULANCE AUTHORITY
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:
1750475281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 WEST STEPHEN STREET
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
MARTINSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-264-1995
Provider Business Mailing Address Fax Number:
304-267-1753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WEST STEPHEN STREET
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-264-1995
Provider Business Practice Location Address Fax Number:
304-267-1753
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COSTELLO
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
304-264-1995

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  NO NUMBER GIVEN , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0144833000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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