Healthcare Provider Details

I. General information

NPI: 1063566305
Provider Name (Legal Business Name): MOUNTAINEER AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 248
TUNNELTON WV
26444-9745
US

IV. Provider business mailing address

PO BOX 999
OCEANA WV
24870-0999
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberNO NUMBER
License Number StateWV

VIII. Authorized Official

Name: CAROLE HARDESTY
Title or Position: BOARD OF DIRECTORS SECRETARY
Credential:
Phone: 304-892-3202