Healthcare Provider Details

I. General information

NPI: 1528879087
Provider Name (Legal Business Name): WEST VIRGINIA LIFELINE AMBULANCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HELEN LN
MOUNT HOPE WV
25880-1451
US

IV. Provider business mailing address

PO BOX 129
BUCKHANNON WV
26201-0129
US

V. Phone/Fax

Practice location:
  • Phone: 304-860-8245
  • Fax: 304-473-8996
Mailing address:
  • Phone: 304-473-8988
  • Fax: 304-473-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW TYLER KIRK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 304-860-8245