Provider Demographics
NPI:1083765127
Name:OLDHAM COUNTY AMBULANCE TAXING DISTRICT
Entity Type:Organization
Organization Name:OLDHAM COUNTY AMBULANCE TAXING DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHAIRMAN OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-222-2890
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
Practice Address - Street 1:1101 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9124
Practice Address - Country:US
Practice Address - Phone:502-222-7250
Practice Address - Fax:502-222-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000070284OtherANTHEM BLUE CROSS
KY1092934OtherPASSPORT
KY55093058Medicaid
KY56015712Medicaid
KY98088OtherCOVENTRY HEALTH MEDICAID MCO
KY590012776OtherRAILROAD MEDICARE
KY590012776OtherRAILROAD MEDICARE