Provider Demographics
NPI:1881677805
Name:METHODIST HEALTH, INC.
Entity Type:Organization
Organization Name:METHODIST HEALTH, INC.
Other - Org Name:METHODIST HOSPITAL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-827-7502
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1083
Mailing Address - Country:US
Mailing Address - Phone:270-826-6558
Mailing Address - Fax:270-826-6362
Practice Address - Street 1:383 BORAX DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-5050
Practice Address - Country:US
Practice Address - Phone:270-826-6558
Practice Address - Fax:270-826-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55051023Medicaid
KY56003767Medicaid
KY55051023Medicaid