Provider Demographics
NPI:1497720072
Name:ELKHORN AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:ELKHORN AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-754-5173
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:800-676-4785
Mailing Address - Fax:
Practice Address - Street 1:223 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522
Practice Address - Country:US
Practice Address - Phone:606-754-5173
Practice Address - Fax:606-754-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1658341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50008744OtherPASSPORT
KY56028855Medicaid
OH2623138Medicaid
KY000000389814OtherANTHEM
VA010223474Medicaid
KY406590993OtherRR MEDICARE
WV1069699OtherWV WORKERS COMP
KY55001234Medicaid
KY610830100OtherBLACK LUNG
KY56028855Medicaid
KY=========OtherTRICARE
OH2623138Medicaid