Provider Demographics
NPI:1619024346
Name:ASHLAND COMMUNITY MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:ASHLAND COMMUNITY MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-324-1101
Mailing Address - Street 1:2200 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7832
Mailing Address - Country:US
Mailing Address - Phone:606-324-1101
Mailing Address - Fax:606-325-2629
Practice Address - Street 1:2200 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7832
Practice Address - Country:US
Practice Address - Phone:606-324-1101
Practice Address - Fax:606-325-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KY332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45900362Medicaid
KY7066OtherCHA HEALTH
KY479258OtherFEDERAL BLACK LUNG
KY57649OtherNORTHWOOD BC BS
KY000000070189OtherANTHEM
KY1366745OtherUNITED MINE WORKERS
KY90020108Medicaid
WV1030656OtherWV WORKERS COMPENSATION
KY163623700OtherFEDERAL WORKERS COMPENSAT
WV0146778000Medicaid
OH0695056Medicaid
WV0146778000Medicaid
KY45900362Medicaid