Healthcare Provider Details

I. General information

NPI: 1780787721
Provider Name (Legal Business Name): BRUCETON MILL COMMUNITY AMBULANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/12/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 UNION STREET
BRUCETON MILLS WV
26525-0084
US

IV. Provider business mailing address

PO BOX 911
MABSCOTT WV
25871-0911
US

V. Phone/Fax

Practice location:
  • Phone: 304-288-3693
  • Fax:
Mailing address:
  • Phone: 304-253-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: TAMMY SPIKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 304-288-3693