# TERRA ALTA COMMUNITY AMBULANCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619969722
- **Authorized official:** MRS. MARILYN JOYCE METHENY (VICE PRESIDENT)
- **Authorized official phone:** (304) 789-6006

## Contact information

- **Practice address:** 1124 E STATE AVE, TERRA ALTA, WV 26764-1465
- **Practice address phone:** (304) 789-6566
- **Practice address fax:** (304) 789-6566
- **Mailing address:** PO BOX 129, BUCKHANNON, WV 26201-0129
- **Mailing address phone:** (304) 473-8988
- **Mailing address fax:** (304) 472-9849

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2005
- **Last updated:** 06/25/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0145535000 | — | WV |
| 05 | — | 409853600 | — | MD |