1487651543 NPI number — LYON COUNTY EMERGENCY AMBULANCE SERVICE

Table of content: (NPI 1487651543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487651543 NPI number — LYON COUNTY EMERGENCY AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYON COUNTY EMERGENCY 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:
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:
1487651543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 COMMERCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDDYVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42038-8294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-388-7167
Provider Business Mailing Address Fax Number:
270-388-7588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 COMMERCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDDYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42038-8294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-388-7167
Provider Business Practice Location Address Fax Number:
270-388-7588
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WIGGINS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
270-388-7167

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1368 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55072011 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000221435 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 590013090 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 310933801 . This is a "FEDERAL BLACK LUNG PROGRAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56004245 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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