Provider Demographics
NPI:1861509911
Name:MCINTOSH AMBULANCE INC
Entity Type:Organization
Organization Name:MCINTOSH AMBULANCE INC
Other - Org Name:MCINTOSH EMPIRE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:606-666-9009
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339
Mailing Address - Country:US
Mailing Address - Phone:606-666-9009
Mailing Address - Fax:606-666-7922
Practice Address - Street 1:171 HOWELL HEIGHTS
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339
Practice Address - Country:US
Practice Address - Phone:606-666-9009
Practice Address - Fax:606-666-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1652146L00000X
KY1649146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000324628OtherANTHEM BLUE CROSS
KY56026511Medicaid
KY55000954Medicaid
KYP00069739OtherMEDICARE RAILROAD
KYP00069739OtherMEDICARE RAILROAD