Basic Information
| Provider Information | |||||||||
| NPI: | 1609914043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCKINNEY AREA RESCUE SQUAD INC TT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707449600 | ||||||||
| FaxNumber: | 2707440834 | ||||||||
| Practice Location | |||||||||
| Address1: | 3305 MIDDLEBURG RD | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404480117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063465300 | ||||||||
| FaxNumber: | 6063465300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 6063465300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1561 | KY | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 000000198881 | 01 | KY | ANTHEM BLUE CROSS | OTHER | 56004310 | 05 | KY | MEDICAID | 590005636 | 01 | RAILROAD MEDICARE | OTHER | 55069066 | 05 | KY | MEDICAID |