MEDICARE: WETZEL COUNTY EMERGENCY AMBULANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance		WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590012567	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	081132300	OTHER	WV	BLACK LUNG
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000204272	OTHER	WV	BLUE CROSS BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093715872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WETZEL COUNTY EMERGENCY AMBULANCE

Provider Business Mailing Address
First Line	:	836 4TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1407
Country	:	US
Telephone Number	:	800-676-4785
Fax Number	:	304-522-4222

Provider Business Practice Location Address
First Line	:	20 EMERGENCY SERVICE LN
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-1152
Country	:	US
Telephone Number	:	304-455-5931
Fax Number	:	304-455-2824

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIMMY COLVIN
Credential	:
Telephone Number	:	304-455-5931

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	12/12/2022

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Directions to “WETZEL COUNTY EMERGENCY AMBULANCE ” Practice Location

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