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General NPI Number Information
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NPI Number | 1720133986
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Entity Type | Organization
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Legal Business Name | WIDENERS AMBULANCE SERVICE, INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 102 MAIN STREET
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City | NORTHFORK
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State | WV
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Zip | 24868
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Country | US
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Telephone | 304-862-4339
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 728
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City | NORTHFORK
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State | WV
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Zip | 24868-0728
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Country | US
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Telephone | 304-862-4339
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MIKE WIDENER
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Credential |
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Telephone | 304-862-4339
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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 | NO NUMBER
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License Number State | WV
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