Provider Demographics
NPI:1023017621
Name:GREENUP COUNTY EMERGENCY MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:GREENUP COUNTY EMERGENCY MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-833-1515
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:1104 POWELL LN
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1614
Practice Address - Country:US
Practice Address - Phone:606-833-1515
Practice Address - Fax:606-833-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000069747OtherANTHEM
OH0725577Medicaid
KY55045041Medicaid
KY56004609Medicaid
WV9000038000Medicaid
KY1110985OtherPASSPORT
KY225704OtherCARELINK
KY55045041Medicaid
KY000000069747OtherANTHEM
KY225704OtherCARELINK
WV9000038000Medicaid