Provider Demographics
NPI:1093872830
Name:WIGGINS DRUGS, LLC
Entity Type:Organization
Organization Name:WIGGINS DRUGS, LLC
Other - Org Name:OHIO CO EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-298-3112
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1123
Mailing Address - Country:US
Mailing Address - Phone:270-298-4415
Mailing Address - Fax:270-298-4417
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1123
Practice Address - Country:US
Practice Address - Phone:270-298-4415
Practice Address - Fax:270-298-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1050341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000373677OtherBLUE CROSS BLUE SHIELD
KY56029499Medicaid
KY55001309Medicaid
KY55001309Medicaid