1922007517 NPI number — PLEASANTS COUNTY EMERGENCY AMBULANCE AUTHORITY

Table of content: (NPI 1922007517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922007517 NPI number — PLEASANTS COUNTY EMERGENCY AMBULANCE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLEASANTS 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:
1922007517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2022
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:
800-676-4785
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT MARYS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26170-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-684-3811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
304-916-0873

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: 590014658 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001705595 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 080042800 . This is a "BLACK LUNG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 225398 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 8040010000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0929357 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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