Basic Information
| Provider Information | |||||||||
| NPI: | 1881693638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESTILL COUNTY EMS | ||||||||
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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: | 22 MERCY COURT | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403361331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067232124 | ||||||||
| FaxNumber: | 6067236610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | WISE | ||||||||
| AuthorizedOfficialFirstName: | JIMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8006764785 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 406590715 | 01 | KY | RR MEDICARE | OTHER | 083445300 | 01 | KY | BLACK LUNG | OTHER | 000000070069 | 01 | KY | ANTHEM | OTHER | 56003916 | 05 | KY | MEDICAID | 1143774 | 01 | KY | PASSPORT | OTHER | 55033013 | 05 | KY | MEDICAID |