Provider Demographics
NPI:1558356444
Name:LAFFERTY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:LAFFERTY ENTERPRISES, INC.
Other - Org Name:TRANS-STAR AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BILLITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-886-7030
Mailing Address - Street 1:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-5263
Mailing Address - Country:US
Mailing Address - Phone:606-886-7030
Mailing Address - Fax:606-886-9322
Practice Address - Street 1:587 N LAKE DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1278
Practice Address - Country:US
Practice Address - Phone:606-886-7030
Practice Address - Fax:606-886-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11883416L0300X
KY13763416L0300X
KY16123416L0300X
KY14293416L0300X
KY16113416L0300X
KY30103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55036099Medicaid
KY080022800OtherFEDERAL BLACK LUNG
KY56008238Medicaid
KY000000070423OtherBLUE CROSS BLUE SHIELD
KY590012760OtherRAILROAD MEDICARE
KY000000070423OtherBLUE CROSS BLUE SHIELD