Provider Demographics
NPI:1144229980
Name:CITY OF CRESCENT SPRINGS KENTUCKY
Entity Type:Organization
Organization Name:CITY OF CRESCENT SPRINGS KENTUCKY
Other - Org Name:CRESCENT SPRINGS VILLA HILLS FIRE & EMS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-341-3840
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:
Practice Address - Street 1:777 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1409
Practice Address - Country:US
Practice Address - Phone:859-341-3840
Practice Address - Fax:859-344-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1434341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000070062OtherANTHEM
KY55059141Medicaid
KY000000070062OtherANTHEM
OH=========00OtherOH WORKERS COMP
KY55059141Medicaid
KY=========OtherUMWA
KY8053701Medicare PIN