Provider Demographics
NPI:1114374402
Name:NORTHWEST WOOD AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:NORTHWEST WOOD AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-352-2884
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:OH
Mailing Address - Zip Code:43522-0216
Mailing Address - Country:US
Mailing Address - Phone:419-352-2884
Mailing Address - Fax:419-352-2884
Practice Address - Street 1:20496 KELLOGG RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:OH
Practice Address - Zip Code:43522-9450
Practice Address - Country:US
Practice Address - Phone:419-352-2884
Practice Address - Fax:419-352-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport