Organization
STAT AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER JASON SMYTH (PRESIDENT)
(304) 732-9112
Entity
Organization
Contact information
Practice address
1 PARK STREET, PINEVILLE, WV 24874
(304) 732-9112
(304) 732-8494
Mailing address
PO BOX 393, GILBERT, WV 25621-0393
(304) 732-9112
(304) 732-8494
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1634
KY
3416L0300X
Land Ambulance
1647
KY
3416L0300X
Land Ambulance
—
WV
343900000X
Non-emergency Medical Transport (VAN)
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350799
BLUE CROSS BLUE SHIELD
KY
05
—
55000913
—
KY
05
—
8005063000
—
WV
Enumeration date
09/09/2005
Last updated
09/11/2025
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