Provider Demographics
NPI:1659411502
Name:FIRST RESPONSE AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:FIRST RESPONSE AMBULANCE SERVICE INC
Other - Org Name:FIRST RESPONSE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-489-8446
Mailing Address - Street 1:171 ABBOTT CREEK ROAD STE 1
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0171
Mailing Address - Country:US
Mailing Address - Phone:606-886-9845
Mailing Address - Fax:606-886-0834
Practice Address - Street 1:209 DEPOT RD
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1413
Practice Address - Country:US
Practice Address - Phone:606-886-9845
Practice Address - Fax:606-886-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56005788Medicaid
KY55058085Medicaid
KY55058085Medicaid