Provider Demographics
NPI:1679560361
Name:GILMER COUNTY AMBULANCE SERVICE
Entity type:Organization
Organization Name:GILMER COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PARAMEDIC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIRBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-462-5695
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-0129
Mailing Address - Country:US
Mailing Address - Phone:304-473-8988
Mailing Address - Fax:304-206-3141
Practice Address - Street 1:230 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1051
Practice Address - Country:US
Practice Address - Phone:304-462-5695
Practice Address - Fax:304-462-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0145299000Medicaid
WV0145299000Medicaid