Healthcare Provider Details

I. General information

NPI: 1821651688
Provider Name (Legal Business Name): WATERFORD TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 4TH STREET
BEVERLY OH
45715-0146
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 740-984-8783
  • Fax:
Mailing address:
  • Phone: 304-521-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JAMES BLACK
Title or Position: CHIEF
Credential:
Phone: 740-350-2344