Provider Demographics
NPI:1184796518
Name:CITY OF WILDWOOD
Entity type:Organization
Organization Name:CITY OF WILDWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:609-522-1110
Mailing Address - Street 1:4400 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-1729
Mailing Address - Country:US
Mailing Address - Phone:609-522-1110
Mailing Address - Fax:
Practice Address - Street 1:4400 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-1729
Practice Address - Country:US
Practice Address - Phone:609-522-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
NJWILD006403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10019669OtherCAPITAL DISTRICT PHYSICIA
NJ54114403OtherAMERIGROUP OF NJ
NJ9730092OtherGHI GROUP HEALTH
NJNK3567OtherHEALTHNET
NJP-NJ7316OtherQUALMED
NJ0061437OtherUS HEALTHCARE
NJ1018658OtherKEYSTONE MERCY HEALTH PLN
NJ5114403Medicaid
NJ00936980000OtherAMERIHEALTH
NJ10019669OtherCAPITAL DISTRICT PHYSICIA
NJ54114403OtherAMERIGROUP OF NJ