Provider Demographics
NPI:1336231224
Name:APPALACHIAN FIRST RESPONSE EMERGENCY SERVICES INC.
Entity Type:Organization
Organization Name:APPALACHIAN FIRST RESPONSE EMERGENCY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-353-9835
Mailing Address - Street 1:180 HOSPITAL DR
Mailing Address - Street 2:BOX 1E
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503
Mailing Address - Country:US
Mailing Address - Phone:606-353-9835
Mailing Address - Fax:606-353-9834
Practice Address - Street 1:1477 POND CREEK RD
Practice Address - Street 2:
Practice Address - City:STONE
Practice Address - State:KY
Practice Address - Zip Code:41567-7055
Practice Address - Country:US
Practice Address - Phone:606-353-9834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55098172Medicaid
KY56005960Medicaid
KY55098172Medicaid