Provider Demographics
NPI:1184665002
Name:HWC AMBULANCE LLC
Entity Type:Organization
Organization Name:HWC AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARLOW
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLWOOD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-744-6100
Mailing Address - Street 1:2545 LORD BALTIMORE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2672
Mailing Address - Country:US
Mailing Address - Phone:410-744-6100
Mailing Address - Fax:410-744-1301
Practice Address - Street 1:2545 LORD BALTIMORE DR
Practice Address - Street 2:SUITE D
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2672
Practice Address - Country:US
Practice Address - Phone:410-744-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD296COtherBCBS OF MD
MD407765200Medicaid
MD407765200Medicaid