Healthcare Provider Details

I. General information

NPI: 1265719256
Provider Name (Legal Business Name): STAT EMS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84-B MAIN AVE
PINEVILLE WV
24874
US

IV. Provider business mailing address

PO BOX 1210
PINEVILLE WV
24874-1210
US

V. Phone/Fax

Practice location:
  • Phone: 304-732-9116
  • Fax: 304-732-9394
Mailing address:
  • Phone: 304-732-9116
  • Fax: 304-732-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number15537
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number15537
License Number StateWV

VIII. Authorized Official

Name: REBECCA JEAN LOVEJOY
Title or Position: OWNER
Credential:
Phone: 304-732-9116