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General NPI Number Information
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NPI Number | 1538501614
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Entity Type | Organization
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Legal Business Name | SOUTHGATE WILDER EMERGENCY MEDICAL SERVICE
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 836 4TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-1407
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Country | US
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Telephone | 304-521-1576
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Fax |
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Provider Business Mailing Address
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Address Line | 128 ELECTRIC AVE
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City | SOUTHGATE
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State | KY
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Zip | 41071-3166
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANTHONY KRAMER
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Credential |
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Telephone | 859-441-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1539
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License Number State | KY
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