1194714253 NPI number — SCOTT COUNTY AMBULANCE SERVICE

Table of content: (NPI 1194714253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194714253 NPI number — SCOTT COUNTY AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT COUNTY AMBULANCE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194714253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18801 ALBERTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEIDA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37841-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-569-6070
Provider Business Mailing Address Fax Number:
423-569-3618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18801 ALBERTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37841-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-569-6070
Provider Business Practice Location Address Fax Number:
423-569-3618
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
423-569-6254

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS0000007601 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55620249 . This is a "KY MEDICAID EMERGENCY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0104093 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3558885 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56005101 . This is a "KY MEDICAID NON EMERGENCY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1403216 . This is a "UMWA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 892010 . This is a "BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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