Healthcare Provider Details

I. General information

NPI: 1336151315
Provider Name (Legal Business Name): BROOKE COUNTY COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MARSHALL STREET
WELLSBURG WV
26070
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 304-737-7094
  • Fax: 304-737-7251
Mailing address:
  • Phone: 304-521-1576
  • Fax: 304-521-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberWVEMS
License Number StateWV

VIII. Authorized Official

Name: K. ROBERT FOWLER
Title or Position: DIRECTOR
Credential:
Phone: 304-737-7094