Provider Demographics
NPI:1891877353
Name:EDMONSON COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:EDMONSON COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:270-597-3721
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0118
Mailing Address - Country:US
Mailing Address - Phone:270-597-3721
Mailing Address - Fax:270-597-9851
Practice Address - Street 1:1755 HWY 259 N.
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-0118
Practice Address - Country:US
Practice Address - Phone:270-597-3721
Practice Address - Fax:270-597-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56003874Medicaid
KY000000077051OtherANTHEM BC/BS
KY163544600OtherU.S. DEPT. OF LABOR
KY55031033Medicaid
KY163544600OtherU.S. DEPT. OF LABOR