1710980347 NPI number — BRACKEN COUNTY AMBULANCE DISTRICT

Table of content: (NPI 1710980347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710980347 NPI number — BRACKEN COUNTY AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRACKEN COUNTY AMBULANCE DISTRICT
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:
BRACKEN COUNTY EMS
Provider Other Organization Name Type Code:
3
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:
1710980347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-522-7533
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
592 BLADESTON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-735-3783
Provider Business Practice Location Address Fax Number:
606-735-2694
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JAYNES
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
606-735-3783

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1145 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 170660801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2504132 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55012017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00652148 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 56003551 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590587008 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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