1396829081 NPI number — WEAKLEY COUNTY AMBULANCE SERVICE, INC.

Table of content: (NPI 1396829081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396829081 NPI number — WEAKLEY COUNTY AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEAKLEY COUNTY AMBULANCE SERVICE, INC.
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:
1396829081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42002-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-744-9600
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8220 HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRESDEN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38225-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-364-5002
Provider Business Practice Location Address Fax Number:
731-364-6728
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
731-364-5002

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS0000009201 , 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: 3374 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 053623 . This is a "OMNI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 118361 . This is a "BETTER HEALTH (UNISON)" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4110073 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 28186 . This is a "TNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3545391 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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