Organization
TYLER COUNTY EMERGENCY SQUAD UNIT ONE MIDDLEBOURNE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARA WELLS (CHIEF)
(304) 758-4067
Entity
Organization
Contact information
Practice address
100 WILCOX AVENUE, MIDDLEBOURNE, WV 26149-9635
(304) 758-4067
(304) 455-4275
Mailing address
836 4TH AVE, HUNTINGTON, WV 25701-1407
(800) 676-4785
(304) 522-4222
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001704940
BLUE CROSS
WV
05
—
0145554001
—
WV
05
—
0273181
—
OH
01
—
080013800
BLACK LUNG
WV
01
—
1407316
UMWA
WV
01
—
251045
CARELINK
WV
01
—
590029271
RAILROAD MEDICARE
WV
Enumeration date
07/19/2005
Last updated
09/21/2016
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