Organization
LOGAN COUNTY EMERGENCY AMBULANCE SERVICE
Active
Other names
LEASA/COUNTY PUBLIC RESCUE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER ELMO BRYANT (EXECUTIVE DIRECTOR)
(304) 752-0917
Entity
Organization
Contact information
Practice address
511 DINGESS ST, LOGAN, WV 25601-3500
(304) 752-0917
(304) 752-7661
Mailing address
511 DINGESS ST, LOGAN, WV 25601-3500
(304) 752-0917
(304) 752-7661
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001705385
BLUE CROSS/BLUE SHIELD
WV
05
—
0145690000
—
WV
01
—
086191300
FEDERAL BLACK LUNG
WV
01
—
1270523
UMWA HEALTH & RET. FUND
WV
01
—
59000469
RAILROAD MEDICARE
WV
01
—
72447ML1
MAMSI
WV
Enumeration date
10/26/2006
Last updated
07/21/2022
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