=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790719631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEIRTON AREA AMBULANCE & RESCUE SQUAD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 02/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 PENNSYLVANIA AVENUE
-----------------------------------------------------
City | WEIRTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-797-1233
-----------------------------------------------------
Fax | 304-748-5445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 PENNSYLVANIA AVENUE
-----------------------------------------------------
City | WEIRTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-797-1233
-----------------------------------------------------
Fax | 304-748-5445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICARE MANAGER
-----------------------------------------------------
Name | MRS. PENNY ANN BRICKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-797-1233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------