Organization
STAFFORD EMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDELL A SIMPSON (OWNER)
(304) 664-2330
Entity
Organization
Contact information
Practice address
4071 VENUS ST, GILBERT, WV 25621-1098
(304) 664-2330
Mailing address
PO BOX 1098, GILBERT, WV 25621-1098
(304) 664-2330
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
045225
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0144793000
—
WV
Enumeration date
10/12/2006
Last updated
09/22/2008
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