Provider Demographics
NPI:1780641035
Name:CLAY COUNTY FISCAL COURT
Entity type:Organization
Organization Name:CLAY COUNTY FISCAL COURT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WAGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-8413
Mailing Address - Street 1:102 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962
Mailing Address - Country:US
Mailing Address - Phone:606-598-8413
Mailing Address - Fax:606-598-1875
Practice Address - Street 1:115 COURT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962
Practice Address - Country:US
Practice Address - Phone:606-598-8413
Practice Address - Fax:606-598-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY057235700OtherBLACK LUNG
KY1069742OtherPASSPORT HEALTH
KY2434809000OtherPASSPORT ADVANTAGE
KY56003734Medicaid
KY000000331660OtherBLUE CROSS BLUE SHIELD
KY55026017Medicaid
OH2577377Medicaid
KY0717614OtherUNITED MINE WORKERS
OH2577377Medicaid
KY057235700OtherBLACK LUNG