Provider Demographics
NPI:1376541201
Name:ANCHORAGE AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:ANCHORAGE AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-376-1278
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:1400 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:KY
Practice Address - Zip Code:40223-1418
Practice Address - Country:US
Practice Address - Phone:502-245-6755
Practice Address - Fax:502-245-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1431341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2434468000OtherPASSPORT ADVANTAGE
KY55056162Medicaid
KY1064754OtherPASSPORT
IN200203420AMedicaid
KY56029705Medicaid
KY00001183289OtherCHA
KY590011748OtherRAILROAD MEDICARE
KY000000070175OtherANTHEM
OH=========00OtherOH WORKERS COMP
KY8033701Medicare PIN