1114969755 NPI number — HARLAN EMERGENCY MEDICAL SERVICES CORPORATION

Table of content: (NPI 1396431144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114969755 NPI number — HARLAN EMERGENCY MEDICAL SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARLAN EMERGENCY MEDICAL SERVICES CORPORATION
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:
HARLAN 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:
1114969755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 169
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLAN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-573-2705
Provider Business Mailing Address Fax Number:
606-573-9777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 ANDERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40831-7275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-2705
Provider Business Practice Location Address Fax Number:
606-573-9777
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
606-573-2721

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1303 , 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: P00163744 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000352805 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 56027832 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08062400 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1088073 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 55001127 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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