MEDICARE: VALLEY DISTRICT AMBULANCE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	NO NUMBER ISSUED	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942256573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY DISTRICT AMBULANCE INC

Provider Business Mailing Address
First Line	:	PO BOX 999
Second Line	:
City	:	OCEANA
State	:	WV
Zip	:	24870-0999
Country	:	US
Telephone Number	:	304-253-1059
Fax Number	:

Provider Business Practice Location Address
First Line	:	10452 VETERANS MEMORIAL HWY
Second Line	:
City	:	MASONTOWN
State	:	WV
Zip	:	26542-0000
Country	:	US
Telephone Number	:	304-854-1197
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT L LISTON
Credential	:
Telephone Number	:	304-854-5100

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	02/05/2014

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