Provider Demographics
NPI:1275530453
Name:TWIN CITY AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:TWIN CITY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-472-8342
Mailing Address - Street 1:105 NOLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-8220
Mailing Address - Country:US
Mailing Address - Phone:731-571-2920
Mailing Address - Fax:270-744-8647
Practice Address - Street 1:105 NOLAN AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-8220
Practice Address - Country:US
Practice Address - Phone:731-571-2920
Practice Address - Fax:270-744-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-04
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55000525Medicaid
KY56020118Medicaid
406590094OtherRR MEDICARE
KY8048801Medicare ID - Type Unspecified