MEDICARE: PLEASANTS COUNTY EMERGENCY AMBULANCE AUTHORITY

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
1	590014658	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	001705595	OTHER	WV	BLUE CROSS
3	080042800	OTHER	WV	BLACK LUNG
4	225398	OTHER	WV	CARELINK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922007517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANTS COUNTY EMERGENCY AMBULANCE AUTHORITY

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	:	406 3RD ST
Second Line	:
City	:	SAINT MARYS
State	:	WV
Zip	:	26170-1402
Country	:	US
Telephone Number	:	304-684-3811
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	THOMAS BAKER
Credential	:
Telephone Number	:	304-916-0873

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/12/2022

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Directions to “PLEASANTS COUNTY EMERGENCY AMBULANCE AUTHORITY ” Practice Location

Language	Start Address	Practice Location

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