Healthcare Provider Details

I. General information

NPI: 1225183718
Provider Name (Legal Business Name): WHITESVILLE AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RALEIGH STREET
WHITESVILLE WV
25209
US

IV. Provider business mailing address

PO BOX 145
WHITESVILLE WV
25209-0145
US

V. Phone/Fax

Practice location:
  • Phone: 304-854-1197
  • Fax:
Mailing address:
  • Phone: 304-854-1197
  • 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: LISA FORD
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-854-1197