1396791208 NPI number — LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT

Table of content: (NPI 1396791208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396791208 NPI number — LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
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:
LOUISVILLE METRO 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:
1396791208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
834 E BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40204-1072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-574-4245
Provider Business Mailing Address Fax Number:
502-574-4368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
834 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40204-1072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-574-4245
Provider Business Practice Location Address Fax Number:
502-574-4368
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
EVETTE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OMB MANAGER
Authorized Official Telephone Number:
502-574-6580

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1650 , 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: 000000247248 . This is a "ANTHEM (BC/BS)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1056313 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080174000 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100017160A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2433855000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 55000814 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8281026 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 012882000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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