Commissioner of Roads & Revenue Wheeler County
Organization Active NPI Land Ambulance · Glenwood, GA
NPI 1629437280 · NPPES record last updated Apr 5, 2021
Key facts
- NPI
- 1629437280
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- COMMISSIONER OF ROADS & REVENUE WHEELER COUNTY
- Practice address
- 18 NW 3Rd Avenue
Glenwood, GA 30428-3730 - Phone
- (125) 232-7009
- Fax
- (912) 523-5600
- NPI assigned
- Feb 11, 2016
- Organization subpart
- No
Authorized official
- Name
- Selena F Howell
- Title
- Director
- Phone
- (912) 423-9692
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2274580 | Wheeler County EMS | Certificate of waiver | Jan 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160418000823 | GA | Part B Supplier - Ambulance Service Supplier | 8820396328 | Practice locations: Glenwood, GA |
National Provider Directory
Locations
20 W Forest Ave
Alamo, GA 30411
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
18 NW 3Rd Avenue
Glenwood, GA 30428-3730
Mailing address
PO Box 9150
Paducah, KY 42002-9150
Phone (270) 744-8413
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003176045A | Medicaid | GA | |
| 710474800 | Other | GA | DOL -FECA/ BL / ENERGY |
| N1207418 | Other | GA | WELLCARE OF GA |
Other names
- Wheeler County Ems
Other providers in Glenwood, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.