Provider Demographics
NPI:1851340848
Name:BRECKINRIDGE COUNTY CENTRAL EMS INC
Entity Type:Organization
Organization Name:BRECKINRIDGE COUNTY CENTRAL EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-756-2367
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
Practice Address - Street 1:807 OLD US 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143
Practice Address - Country:US
Practice Address - Phone:270-756-5525
Practice Address - Fax:270-756-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2436130000OtherPASSPORT ADVANTAGE
KY56008626Medicaid
KY000000070433OtherBLUE CROSS BLUE SHIELD
KY1096547OtherPASSPORT HEALTH
KY080027200OtherBLACK LUNG
KY55014054Medicaid
KY590013172OtherRAILROAD MEDICARE
KY2436130000OtherPASSPORT ADVANTAGE