1609914043 NPI number — MCKINNEY AREA RESCUE SQUAD INC TT

Table of content: (NPI 1609914043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609914043 NPI number — MCKINNEY AREA RESCUE SQUAD INC TT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCKINNEY AREA RESCUE SQUAD INC TT
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:
1609914043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2013
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:
270-744-0834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3305 MIDDLEBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40448-0117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-346-5300
Provider Business Practice Location Address Fax Number:
606-346-5300
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
606-346-5300

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1561 , 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: 000000198881 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 56004310 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590005636 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55069066 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".