MEDICARE: WAYNE COUNTY FISCAL COURT

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	1648	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00300479	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000328512	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
5	2626308000	OTHER	KY	PASSPORT ADVANTAGE
6	610617500	OTHER	KY	BLACK LUNG
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	50008672	OTHER	KY	PASSPORT
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871593608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE COUNTY FISCAL COURT

Provider Business Mailing Address
First Line	:	836 4TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1407
Country	:	US
Telephone Number	:	800-676-4785
Fax Number	:	304-522-4222

Provider Business Practice Location Address
First Line	:	111 JIM HILL SERVICE RD
Second Line	:
City	:	MONTICELLO
State	:	KY
Zip	:	42633-7901
Country	:	US
Telephone Number	:	606-348-3301
Fax Number	:	606-348-3304

Authorized Official
Title or Position	:	CHIEF
Name	:	SHERWIN CORDER
Credential	:
Telephone Number	:	606-348-3301

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/28/2009

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Directions to “WAYNE COUNTY FISCAL COURT ” Practice Location

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