Provider Demographics
NPI:1679530497
Name:REGIONAL TRANSPORT
Entity Type:Organization
Organization Name:REGIONAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER ASST DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCKIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-759-5993
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41096
Mailing Address - Country:US
Mailing Address - Phone:606-759-5993
Mailing Address - Fax:606-759-8426
Practice Address - Street 1:1910 OLD MAIN
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056
Practice Address - Country:US
Practice Address - Phone:606-759-5993
Practice Address - Fax:606-759-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16453416L0300X
KY30033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000224891OtherBLUE CROSS BLUE SHIELD
KY2445746000OtherPASSPORT ADVANTAGE
OH2323275Medicaid
WV3810004113Medicaid
KY55000608OtherMEDICAID UNISYS 55
KY56021447OtherMEDICAID UNISYS 56
KY8050401OtherFEDERAL MEDICARE
PA1010495910001Medicaid
KY50004381OtherPASSPORT HEALTH
KY800434OtherBLACK LUNG