Basic Information
| Provider Information | |||||||||
| NPI: | 1386661049 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LARUE COUNTY COUNTY TREASURER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LARUE COUNTY EMS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707449600 | ||||||||
| FaxNumber: | 2707448642 | ||||||||
| Practice Location | |||||||||
| Address1: | 924 S LINCOLN BLVD | ||||||||
| Address2: | |||||||||
| City: | HODGENVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703584071 | ||||||||
| FaxNumber: | 2703584093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COTTRELL | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2703584071 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1361 | KY | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 590003506 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000070448 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | 56005432 | 01 | KY | MEDICAID UNISYS 56 | OTHER | 1074427 | 01 | KY | PASSPORT HEALTH | OTHER | 2435164000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 55062012 | 01 | KY | MEDICAID UNISYS 55 | OTHER |