Provider Demographics
NPI:1013958164
Name:ELLIOTT COUNTY AMBULANCE SERVICE
Entity type:Organization
Organization Name:ELLIOTT COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-484-1060
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
Practice Address - Street 1:59 AMBULANCE RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171
Practice Address - Country:US
Practice Address - Phone:606-738-4132
Practice Address - Fax:606-738-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000220515OtherBLUE CROSS BLUE SHIELD
KY55000673Medicaid
KY080044800OtherBLACK LUNG
KY080044800OtherUS DEPARTMENT OF LABOR
KY56022023Medicaid
KY590015174OtherRAILROAD MEDICARE
KY080044800OtherBLACK LUNG