Provider Demographics
NPI:1629437280
Name:COMMISSIONER OF ROADS & REVENUE WHEELER COUNTY
Entity Type:Organization
Organization Name:COMMISSIONER OF ROADS & REVENUE WHEELER COUNTY
Other - Org Name:WHEELER COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-423-9692
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-8413
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:18 NW 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30428-3730
Practice Address - Country:US
Practice Address - Phone:125-232-7009
Practice Address - Fax:912-523-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176045AMedicaid
GA710474800OtherDOL -FECA/ BL / ENERGY
GAN1207418OtherWELLCARE OF GA