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General NPI Number Information
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NPI Number | 1063501153
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Entity Type | Organization
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Legal Business Name | STAFFORD EMS
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 4071 VENUS ST
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City | GILBERT
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State | WV
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Zip | 25621-1098
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Country | US
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Telephone | 304-664-2330
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1098
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City | GILBERT
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State | WV
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Zip | 25621-1098
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Country | US
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Telephone | 304-664-2330
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENDELL A SIMPSON
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Credential |
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Telephone | 304-664-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 045225
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License Number State | WV
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