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General NPI Number Information
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NPI Number | 1316334972
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Entity Type | Organization
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Legal Business Name | HEALTHTEAM CRITICAL CARE TRANSPORT LLC
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 3211 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1211
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Country | US
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Telephone | 304-340-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 110 WYOMING ST
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City | CHARLESTON
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State | WV
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Zip | 25302-2340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CLINTON BURLEY
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Credential |
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Telephone | 304-340-2000
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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 |
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License Number State |
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