Healthcare Provider Details

I. General information

NPI: 1497858955
Provider Name (Legal Business Name): MCDOWELL COUNTY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 VIRGINIA AVE
WELCH WV
24801-2814
US

IV. Provider business mailing address

PO BOX AG
WELCH WV
24801-3052
US

V. Phone/Fax

Practice location:
  • Phone: 304-436-3877
  • Fax:
Mailing address:
  • Phone: 304-436-3877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY SUE SHELTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-436-3877