Basic Information
| Provider Information | |||||||||
| NPI: | 1164412490 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEVIER COUNTY AMBULANCE SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707448413 | ||||||||
| FaxNumber: | 2707448642 | ||||||||
| Practice Location | |||||||||
| Address1: | 718 MIDDLE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | SEVIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378625019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654533248 | ||||||||
| FaxNumber: | 8654534232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | WATERS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | LARRY | ||||||||
| AuthorizedOfficialTitleorPosition: | COUNTY MAYOR | ||||||||
| AuthorizedOfficialTelephone: | 8654533248 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 100020918 | 01 | TN | PHP TENNCARE ID # | OTHER | 246638 | 01 | KY | ANTHEM BC ID # | OTHER | 702002153 | 01 | TN | CARITEN ID # | OTHER | 4110001 | 01 | TN | BLUE CROSS OF TN ID # | OTHER | 9637 | 01 | TN | BLUE CROSS ID # | OTHER | 3524914 | 05 | TN | MEDICAID |