=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952301764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELK DISTRICT AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2005
-----------------------------------------------------
Last Update Date | 03/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MAPLE STREET
-----------------------------------------------------
City | ELK GARDEN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-446-5519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 836 4TH AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-676-4785
-----------------------------------------------------
Fax | 304-522-4222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CAPTAIN
-----------------------------------------------------
Name | ARTHUR D. WELCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-446-5519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------