1932166758 NPI number — GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT

Table of content: (NPI 1932166758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932166758 NPI number — GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN COUNTY AMBULANCE SERVICE TAXING 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:
GREEN COUNTY AMBULANCE SERVICE
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:
1932166758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-5011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-824-8123
Provider Business Mailing Address Fax Number:
270-824-8140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 DAKOTA MEYER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42743-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-932-7414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEATHAM
Authorized Official First Name:
NICK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-932-7414

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1467 , 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: 709849300 . This is a "DOL - FECA / BL/ ENERGY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1068230 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 55044028 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56004005 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000070265 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2434679000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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