Provider Demographics
NPI:1619145844
Name:RUSSELL COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:RUSSELL COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COOTS
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:270-343-1440
Mailing Address - Street 1:108 FERCO WAY
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629-2438
Mailing Address - Country:US
Mailing Address - Phone:270-343-6464
Mailing Address - Fax:270-343-6462
Practice Address - Street 1:108 FERCO WAY
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629-2438
Practice Address - Country:US
Practice Address - Phone:270-343-6464
Practice Address - Fax:270-343-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56005283Medicaid
KY55104038Medicaid
KY55104038Medicaid