Provider Demographics
NPI:1891792362
Name:ALLENS AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:ALLENS AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-593-5849
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:83 MAIN STREET
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314-0083
Mailing Address - Country:US
Mailing Address - Phone:606-593-5849
Mailing Address - Fax:606-593-5237
Practice Address - Street 1:83 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314
Practice Address - Country:US
Practice Address - Phone:606-593-5849
Practice Address - Fax:606-593-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56003379Medicaid
KY55095020Medicaid
KY56003379Medicaid