Tyler County Emergency Squad Unit One Middlebourne Inc

Primary specialty

Land AmbulanceTaxonomy code 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

Last updated

Sep 21, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Clara Wells

Title

Chief

Phone

(304) 758-4067

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1982603270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 4TH AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257011407",
            "telephone_number": "800-676-4785",
            "fax_number": "304-522-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WILCOX AVENUE",
            "city": "MIDDLEBOURNE",
            "state": "WV",
            "postal_code": "261499635",
            "telephone_number": "304-758-4067",
            "fax_number": "304-455-4275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER COUNTY EMERGENCY SQUAD UNIT ONE MIDDLEBOURNE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "CLARA",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "304-758-4067"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Marie Rymer
• Aubrey Ann Smith
• Betty Lou Smith
• Justin Taylor
• Miranda Taylor
• Rosetta Underwood, M.A., ED.S.
• Kelsi Grace Vandruff
• Jennifer Marie Vincent
• Rebecca Sue Wade
• Olivia Faith Walker

• Land Ambulance in Middlebourne, WV
• Providers in Middlebourne, WV by specialty
• Land Ambulance in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.