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General NPI Number Information
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NPI Number | 1528879087
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Entity Type | Organization
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Legal Business Name | WEST VIRGINIA LIFELINE AMBULANCE SERVICES LLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 101 HELEN LN
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City | MOUNT HOPE
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State | WV
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Zip | 25880-1451
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Country | US
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Telephone | 304-860-8245
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Fax | 304-473-8996
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | BUCKHANNON
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State | WV
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Zip | 26201-0129
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Country | US
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Telephone | 304-473-8988
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Fax | 304-473-8996
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MATTHEW TYLER KIRK
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Credential |
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Telephone | 304-860-8245
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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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