Tyler County Emergency Squad Unit One Middlebourne Inc
Organization Active NPI Land Ambulance · Middlebourne, WV
NPI 1982603270 · NPPES record last updated Sep 21, 2016
Key facts
- NPI
- 1982603270
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- TYLER COUNTY EMERGENCY SQUAD UNIT ONE MIDDLEBOURNE INC
- Practice address
- 100 Wilcox Avenue
Middlebourne, WV 26149-9635 - Phone
- (304) 758-4067
- Fax
- (304) 455-4275
- NPI assigned
- Jul 19, 2005
- Organization subpart
- No
Authorized official
- Name
- Clara Wells
- Title
- Chief
- Phone
- (304) 758-4067
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031210000264 | WV | Part B Supplier - Ambulance Service Supplier | 1355247487 | Practice locations: Middlebourne, WV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | WV | Yes |
Addresses
Primary practice location
100 Wilcox Avenue
Middlebourne, WV 26149-9635
Mailing address
836 4TH Ave
Huntington, WV 25701-1407
Phone (800) 676-4785
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0145554001 | Medicaid | WV | |
| 1407316 | Other | WV | UMWA |
| 251045 | Other | WV | CARELINK |
| 001704940 | Other | WV | BLUE CROSS |
| 080013800 | Other | WV | BLACK LUNG |
| 590029271 | Other | WV | RAILROAD MEDICARE |
| 0273181 | Medicaid | OH |
Other providers in Middlebourne, WV
- Amanda Dawn Rymer
- Danielle Marie Rymer
- Betty Lou Smith
- Justin Taylor
- Miranda Taylor
- Rosetta Underwood
- Kelsi Grace Vandruff
- Jennifer Marie Vincent
- Rebecca Sue Wade
- Jolee Michelle Walton
All providers in Middlebourne, WV · Land Ambulance in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.