Provider Demographics
NPI:1508865346
Name:CITY OF CAMPBELLSVILLE KY
Entity Type:Organization
Organization Name:CITY OF CAMPBELLSVILLE KY
Other - Org Name:CAMPBELLSVILLE TAYLOR COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-465-3504
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:304-522-4222
Practice Address - Street 1:105 SOUTH COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1337
Practice Address - Country:US
Practice Address - Phone:270-465-6717
Practice Address - Fax:270-789-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1864176Medicaid
KY086909900OtherBLACK LUNG
KY56027774Medicaid
KY2445149000OtherPASSPORT ADVANTAGE
IN200201650AMedicaid
KY55001101Medicaid
KYP00248582OtherRAILROAD MEDICARE
KY000000340594OtherANTHEM
OH2645221Medicaid
KY1063010OtherPASSPORT
KY=========OtherTRICARE
KY8053201Medicare PIN