MEDICARE: BRUCETON MILL COMMUNITY AMBULANCE, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780787721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCETON MILL COMMUNITY AMBULANCE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 911
Second Line	:
City	:	MABSCOTT
State	:	WV
Zip	:	25871-0911
Country	:	US
Telephone Number	:	304-253-1059
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 UNION STREET
Second Line	:
City	:	BRUCETON MILLS
State	:	WV
Zip	:	26525-0084
Country	:	US
Telephone Number	:	304-288-3693
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TAMMY SPIKER
Credential	:
Telephone Number	:	304-288-3693

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	01/12/2024

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