Basic Information
| Provider Information | |||||||||
| NPI: | 1871593608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAYNE COUNTY FISCAL COURT | ||||||||
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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: | 111 JIM HILL SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 426337901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063483301 | ||||||||
| FaxNumber: | 6063483304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | CORDER | ||||||||
| AuthorizedOfficialFirstName: | SHERWIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 6063483301 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1648 | LA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | P00300479 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000328512 | 01 | KY | ANTHEM | OTHER | 4287026 | 05 | TN | MEDICAID | 56026529 | 05 | KY | MEDICAID | 2626308000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 610617500 | 01 | KY | BLACK LUNG | OTHER | 2502518 | 05 | OH | MEDICAID | 50008672 | 01 | KY | PASSPORT | OTHER | 55000970 | 05 | KY | MEDICAID |