Basic Information
| Provider Information | |||||||||
| NPI: | 1336149178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODLAWN FIRE DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006764785 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 WATERWORKS RD | ||||||||
| Address2: | |||||||||
| City: | WOODLAWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410712522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594416661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZILLIOX | ||||||||
| AuthorizedOfficialFirstName: | JUDE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8594416661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1533 | KY | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 55019095 | 05 | KY | MEDICAID |