Provider Demographics
NPI:1275583577
Name:CITY OF MIDDLESBORO
Entity Type:Organization
Organization Name:CITY OF MIDDLESBORO
Other - Org Name:MIDDLESBORO FIRE DEPARTMENT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-242-2332
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:270-821-8140
Practice Address - Street 1:121 LOTHBURY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-242-2332
Practice Address - Fax:606-248-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2444347000OtherPASSPORT ADVANTAGE
TN4581343Medicaid
KY55007058Medicaid
KY000000070466OtherBLUE CROSS BLUE SHIELD
KY56003692Medicaid
VA010085713Medicaid
KY086252100OtherBLACK LUNG
KY50002872Medicaid
KY590000492OtherRAILROAD MEDICARE
KY0941689OtherUNITED MINE WORKERS