Provider Demographics
NPI:1457358632
Name:CITY OF PROVIDENCE OFFICE OF TREASURER
Entity Type:Organization
Organization Name:CITY OF PROVIDENCE OFFICE OF TREASURER
Other - Org Name:PROVIDENCE FIRE DEPT - EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-667-2011
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 1:220 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:KY
Practice Address - Zip Code:42450-1273
Practice Address - Country:US
Practice Address - Phone:270-667-2011
Practice Address - Fax:270-667-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-04
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY631082OtherWELLCARE - MA MCO
KY93147OtherCOVENTRY HEALTHCARE - MA MCO
KY000000213260OtherANTHEM BLUE CROSS
086992600OtherFEDERAL BLACK LUNG PROGRAM
KY56004658Medicaid
KY50009902OtherPASSPORT HEALTH - MA MCO
KY55117014Medicaid
P00120974Medicare PIN
KY93147OtherCOVENTRY HEALTHCARE - MA MCO