=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639378581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WETZEL COUNTY EMERGENCY AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 05/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PENNSYLVANIA AVENUE ROUTE 69
-----------------------------------------------------
City | HUNDRED
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-455-5931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 836 4TH AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-522-7533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | CARLA MCBEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-455-5931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | WV EMS
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------