Healthcare Provider Details

I. General information

NPI: 1164459566
Provider Name (Legal Business Name): QUINWOOD EMERGENCY AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MCCLUNG ST
QUINWOOD WV
25981-0253
US

IV. Provider business mailing address

PO BOX 253 111 MCCLUNG ST
QUINWOOD WV
25981-0253
US

V. Phone/Fax

Practice location:
  • Phone: 304-438-9252
  • Fax: 304-438-7148
Mailing address:
  • Phone: 304-438-9252
  • Fax: 304-438-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number31344
License Number StateWV

VIII. Authorized Official

Name: MRS. SERENA J DAVIS
Title or Position: PT ACCOUNTS
Credential:
Phone: 304-438-9252