Provider Demographics
NPI:1710980347
Name:BRACKEN COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:BRACKEN COUNTY AMBULANCE DISTRICT
Other - Org Name:BRACKEN COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-735-3783
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-522-7533
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:592 BLADESTON DRIVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41004
Practice Address - Country:US
Practice Address - Phone:606-735-3783
Practice Address - Fax:606-735-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170660801Medicaid
OH2504132Medicaid
KY55012017Medicaid
KYP00652148OtherRAILROAD MEDICARE
KY56003551Medicaid
KY590587008OtherRAILROAD MEDICARE
OH2504132Medicaid