Provider Demographics
NPI:1437157617
Name:JACKSON COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:JACKSON COUNTY AMBULANCE SERVICE
Other - Org Name:JACKSON COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR / CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-287-7782
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:270-824-8140
Practice Address - Street 1:1035 MCCAMMON RIDGE RD
Practice Address - Street 2:
Practice Address - City:MC KEE
Practice Address - State:KY
Practice Address - Zip Code:40447-6320
Practice Address - Country:US
Practice Address - Phone:606-287-7782
Practice Address - Fax:606-287-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710039510Medicaid
KY590012826OtherRAILROAD MEDICARE
KY611013432008OtherTRICARE
KY080018700OtherBLACK LUNG
KY50007214OtherPASSPORT
KY000000563913OtherANTHEM BLUE CROSS BLUE SHIELD
IN200225150AMedicaid
KY710039520Medicaid
KY611013432OtherUMWA
KY2448379000OtherPASSPORT ADVANTAGE
IN200225150AMedicaid