Provider Demographics
NPI:1780683532
Name:CITY OF FORT MITCHELL OFFICE OF TREASURER
Entity Type:Organization
Organization Name:CITY OF FORT MITCHELL OFFICE OF TREASURER
Other - Org Name:FORT MITCHELL LIFE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-331-1267
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:2355 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2948
Practice Address - Country:US
Practice Address - Phone:859-331-1267
Practice Address - Fax:859-331-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513613Medicaid
KY000001199826OtherCHA
KY000000039205OtherANTHEM
KY55059166Medicaid
KY590011461OtherRAILROAD MEDICARE
OH2513613Medicaid
KY56007339Medicaid
KY55059166Medicaid
KY000001199826OtherCHA
KY000001199826OtherCHA