Healthcare Provider Details

I. General information

NPI: 1689877003
Provider Name (Legal Business Name): TUCKER COUNTY AMBULANCE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 FIRST STREET
PARSONS WV
26287-1046
US

IV. Provider business mailing address

PO BOX 129
BUCKHANNON WV
26201-0129
US

V. Phone/Fax

Practice location:
  • Phone: 304-478-2296
  • Fax:
Mailing address:
  • Phone: 304-473-8988
  • Fax: 304-206-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberWVEMS
License Number StateWV

VIII. Authorized Official

Name: SHEILA A. MAVSH
Title or Position: DIRECTOR
Credential:
Phone: 304-478-2296