Basic Information
| Provider Information | |||||||||
| NPI: | 1578562898 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLEMING COUNTY AMBULANCE DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | FLEMING COUNTY EMS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006764785 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 2343 KY HWY 11 | ||||||||
| Address2: | |||||||||
| City: | FLEMINGSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068454444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ELDRIDGE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 6068454444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 1147 | KY | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 56003924 | 05 | KY | MEDICAID | 2065296 | 05 | OH | MEDICAID | 55035059 | 05 | KY | MEDICAID | 000000039201 | 01 | KY | ANTHEM | OTHER | 59007347 | 01 | KY | RAILROAD MEDICARE | OTHER |