Provider Demographics
NPI:1427007368
Name:MADISON COUNTY EMS
Entity Type:Organization
Organization Name:MADISON COUNTY EMS
Other - Org Name:MADISON CO EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-5121
Mailing Address - Street 1:556 S KEENELAND DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3232
Mailing Address - Country:US
Mailing Address - Phone:859-623-5121
Mailing Address - Fax:859-626-0340
Practice Address - Street 1:556 S KEENELAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-623-5121
Practice Address - Fax:859-623-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55076020Medicaid
KY000000069991OtherBLUE CROSS BLUE SHIELD
KY590587039OtherRAILROAD MEDICARE
KY56005259Medicaid
KY2438581000OtherPASSPORT ADVANTAGE
PA1011742950001Medicaid
KY55076020Medicaid
KY56005259Medicaid
KY590587039OtherRAILROAD MEDICARE
FL913573100Medicaid
KY087354900OtherBLACK LUNG
KY590587039OtherRAILROAD MEDICARE