Provider Demographics
NPI:1821067737
Name:WAYNE COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:WAYNE COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-842-7346
Mailing Address - Street 1:501 SW 7TH ST
Mailing Address - Street 2:PO BOX 92
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-1470
Mailing Address - Country:US
Mailing Address - Phone:618-842-7346
Mailing Address - Fax:618-847-4019
Practice Address - Street 1:501 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-1470
Practice Address - Country:US
Practice Address - Phone:618-842-7346
Practice Address - Fax:618-847-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL676970Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID