Basic Information
| Provider Information | |||||||||
| NPI: | 1720086721 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARION COUNTY COUNTY TREASURER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | MARION COUNTY FISCAL COURT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006764785 | ||||||||
| FaxNumber: | 3045224222 | ||||||||
| Practice Location | |||||||||
| Address1: | 436 W WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400331347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706926666 | ||||||||
| FaxNumber: | 2706922941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 06/08/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | ROBBIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 2706926666 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1470 | KY | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 2434446000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 000000070452 | 01 | KY | ANTHEM | OTHER | 56004252 | 05 | KY | MEDICAID | 1064466 | 01 | KY | PASSPORT | OTHER | 55078026 | 05 | KY | MEDICAID | 590011545 | 01 | KY | RAILROAD MEDICARE | OTHER |