Provider Demographics
NPI:1558368738
Name:HOPKINSVILLE-CHRISTIAN COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:HOPKINSVILLE-CHRISTIAN COUNTY AMBULANCE SERVICE
Other - Org Name:HOPKINSVILLE CHRISTIAN COUNTY EMERGENCY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-890-1400
Mailing Address - Street 1:PO BOX 117658
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7658
Mailing Address - Country:US
Mailing Address - Phone:270-890-1400
Mailing Address - Fax:270-632-2060
Practice Address - Street 1:112 PHILLIP MEACHAM WAY
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2340
Practice Address - Country:US
Practice Address - Phone:270-890-1400
Practice Address - Fax:270-632-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-04
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
KY10193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
083440000OtherUMWA HEALTH & RETIREMENT
609250800OtherFEDERAL BLACK LUNG PROGRAM
KY55001374Medicaid
KY56029697Medicaid
TN4582421Medicaid
KYN296272OtherWELLCARE, MCO MEDICAID
KY92271OtherCOVENTRY CARES, MCO MEDICAID
KY000000070306OtherANTHEM BLUE CROSS
KY92271OtherCOVENTRY CARES, MCO MEDICAID
TN4582421Medicaid
KY8020601Medicare PIN