Provider Demographics
NPI:1700900487
Name:SPENCER COUNTY TREASURER
Entity Type:Organization
Organization Name:SPENCER COUNTY TREASURER
Other - Org Name:SPENCER COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-477-3244
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-0397
Mailing Address - Country:US
Mailing Address - Phone:502-477-3205
Mailing Address - Fax:502-477-3206
Practice Address - Street 1:66 SPEARS DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-6756
Practice Address - Country:US
Practice Address - Phone:502-477-3244
Practice Address - Fax:502-477-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13533416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56004765Medicaid
KY1067333Medicaid
KY590000280OtherTRAVELERS
KY000000070460OtherANTHEM BC BS
KY55108013Medicaid
KY2434669000Medicare ID - Type UnspecifiedPASSPORT ADVANTAGE
KY55108013Medicaid