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	341600000X	Ambulance	WV EMS	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	590012566	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001705439	OTHER	WV	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	081132300	OTHER	WV	BLACK LUNG
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811196769
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	:	304-522-7533
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 2 BOX 83
Second Line	:
City	:	PROCTOR
State	:	WV
Zip	:	26055-9716
Country	:	US
Telephone Number	:	304-455-5931
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	JIM COLVIN
Credential	:
Telephone Number	:	304-455-5931

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	05/13/2009

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Directions to “WETZEL COUNTY EMERGENCY AMBULANCE ” Practice Location

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