1558368738 NPI number — HOPKINSVILLE-CHRISTIAN COUNTY AMBULANCE SERVICE

Table of content: (NPI 1558368738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558368738 NPI number — HOPKINSVILLE-CHRISTIAN COUNTY AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPKINSVILLE-CHRISTIAN 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:
1558368738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 117658
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-7658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-890-1400
Provider Business Mailing Address Fax Number:
270-632-2060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 PHILLIP MEACHAM WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-890-1400
Provider Business Practice Location Address Fax Number:
270-632-2060
Provider Enumeration Date:
07/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FUTRELL
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
270-890-1400

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1019 , 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: 083440000 . This is a "UMWA HEALTH & RETIREMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 609250800 . This is a "FEDERAL BLACK LUNG PROGRAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55001374 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56029697 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582421 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: N296272 . This is a "WELLCARE, MCO MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 92271 . This is a "COVENTRY CARES, MCO MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000070306 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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