1932166758 NPI number — GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932166758 NPI number — GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT
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:
GREEN COUNTY AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
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:
1932166758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2021
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:
55 DAKOTA MEYER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42743-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-932-7414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEATHAM
Authorized Official First Name:
NICK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-932-7414

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1467 , 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: 709849300 . This is a "DOL - FECA / BL/ ENERGY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1068230 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 55044028 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56004005 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000070265 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2434679000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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