1336149178 NPI number — WOODLAWN FIRE DEPARTMENT

Table of content: (NPI 1336149178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336149178 NPI number — WOODLAWN FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLAWN FIRE DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336149178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-676-4785
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 WATERWORKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41071-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-441-6661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZILLIOX
Authorized Official First Name:
JUDE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
859-441-6661

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1533 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55019095 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com