=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730886326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF JEFFERSON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2023
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 16TH AVE
-----------------------------------------------------
City | RANSON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25438-5732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-728-5613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 836 4TH AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-521-1576
-----------------------------------------------------
Fax | 304-521-1576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | THEODORE M SINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-728-5613
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------