=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588631980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF WAYNE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2006
-----------------------------------------------------
Last Update Date | 08/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7336 ROUTE 31
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-768-2192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 547
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60090-0547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | JIM LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-946-5712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 0731
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------