Provider Demographics
NPI:1003015355
Name:MURRAYVILLE WOODSON EMERGENCY AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:MURRAYVILLE WOODSON EMERGENCY AMBULANCE SERVICE, INC.
Other - Org Name:MWEAS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1217-882-3114
Mailing Address - Street 1:1930 STATE HIGHWAY 267
Mailing Address - Street 2:
Mailing Address - City:MURRAYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62668
Mailing Address - Country:US
Mailing Address - Phone:217-882-3114
Mailing Address - Fax:217-882-7091
Practice Address - Street 1:1930 STATE HIGHWAY 267
Practice Address - Street 2:
Practice Address - City:MURRAYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62668
Practice Address - Country:US
Practice Address - Phone:217-882-3114
Practice Address - Fax:217-882-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL330163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL771800Medicare PIN