MEDICARE: CITY OF FT. WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	1477	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50016080	OTHER	KY	PASSPORT
2	000000069984	OTHER	KY	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295734051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF FT. WRIGHT

Provider Business Mailing Address
First Line	:	836 4TH AVENUE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701
Country	:	US
Telephone Number	:	304-522-7533
Fax Number	:	304-522-4222

Provider Business Practice Location Address
First Line	:	409 KYLES LN
Second Line	:
City	:	FORT WRIGHT
State	:	KY
Zip	:	41011-3743
Country	:	US
Telephone Number	:	859-331-2600
Fax Number	:	859-331-0454

Authorized Official
Title or Position	:	CHIEF
Name	:	STEVE SCHEWE
Credential	:
Telephone Number	:	859-331-2600

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	04/20/2008

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Directions to “CITY OF FT. WRIGHT ” Practice Location

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