Provider Demographics
NPI:1851390603
Name:CASEY CO AMBULANCE TAX BOARD INC
Entity Type:Organization
Organization Name:CASEY CO AMBULANCE TAX BOARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-787-8350
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:1167 CAMPBELLSVILLE ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3367
Practice Address - Country:US
Practice Address - Phone:606-787-8350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1327341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55023022Medicaid
KY000001165698OtherCHA
KY56003676Medicaid
KY2435839000OtherPASSPORT ADVANTAGE
KY000000190651OtherANTHEM
KY590013070OtherRAILROAD MEDICARE
KY1088661OtherPASSPORT
KY55023022Medicaid
KY2435839000OtherPASSPORT ADVANTAGE
KY2435839000OtherPASSPORT ADVANTAGE