MEDICARE: PORT WILLIAM-LIBERTY TOWNSHIP JOINT FIRE AND EMS DISTRICT

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	3416L0300X	Land Ambulance	EMS020327100	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	710731700	OTHER	OH	DOL - FECA /BL / ENERGY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144655283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT WILLIAM-LIBERTY TOWNSHIP JOINT FIRE AND EMS DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 9150
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42002-9150
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-0834

Provider Business Practice Location Address
First Line	:	7211 NORTH STREET RT. 134
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-9629
Country	:	US
Telephone Number	:	937-414-0085
Fax Number	:	937-486-5300

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RONALD STRYKER
Credential	:
Telephone Number	:	937-414-0085

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	12/17/2021

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