Basic Information
| Provider Information | |||||||||
| NPI: | 1851390603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASEY CO AMBULANCE TAX BOARD INC | ||||||||
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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: | 1167 CAMPBELLSVILLE ST | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425393367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067878350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | MALCOLM | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6067878350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 1327 | KY | N | Transportation Services | Ambulance | Land Transport | 341600000X | 1327 | KY | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 55023022 | 05 | KY | MEDICAID | 000001165698 | 01 | KY | CHA | OTHER | 56003676 | 05 | KY | MEDICAID | 2435839000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 000000190651 | 01 | KY | ANTHEM | OTHER | 590013070 | 01 | KY | RAILROAD MEDICARE | OTHER | 1088661 | 01 | KY | PASSPORT | OTHER |