1245637255 NPI number — BREATHITT COUNTY AMBULANCE, INC.

Table of content: (NPI 1245637255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245637255 NPI number — BREATHITT COUNTY AMBULANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREATHITT COUNTY AMBULANCE, 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:
1245637255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 170
Provider Second Line Business Mailing Address:
440 HWY 1812 N
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41339-0170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-666-8911
Provider Business Mailing Address Fax Number:
606-666-7922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 HIGHWAY 1812 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-666-8911
Provider Business Practice Location Address Fax Number:
606-666-7922
Provider Enumeration Date:
11/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCINTOSH
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-666-8911

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1649 , 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)





Copyright © 2007-2025 www.npivalidator.com