1437157617 NPI number — JACKSON COUNTY AMBULANCE SERVICE

Table of content: (NPI 1437157617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437157617 NPI number — JACKSON COUNTY AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON COUNTY AMBULANCE SERVICE
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:
6
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:
1437157617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2023
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:
1035 MCCAMMON RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KEE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40447-6320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-287-7782
Provider Business Practice Location Address Fax Number:
606-287-4199
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOWLES
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR / CHIEF OF OPERATIONS
Authorized Official Telephone Number:
606-287-7782

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1407 , 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: 710039510 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590012826 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 611013432008 . This is a "TRICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 080018700 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50007214 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000563913 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200225150A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710039520 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611013432 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2448379000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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