1780682773 NPI number — MONTGOMERY COUNTY AMBULANCE

Table of content: (NPI 1780682773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780682773 NPI number — MONTGOMERY COUNTY AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY COUNTY AMBULANCE
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:
1780682773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-676-4785
Provider Business Mailing Address Fax Number:
304-522-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 INDIAN MOUND DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-498-1318
Provider Business Practice Location Address Fax Number:
859-498-3809
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
POTTER
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
859-498-1318

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1445 , 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: 610988811 . This is a "TRICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50005079 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200528290A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2593297 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55087043 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56004435 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590001325 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000070315 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 606386600 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com