Provider Demographics
NPI:1780868703
Name:KNOX COUNTY AMBULANCE SERVICE
Entity type:Organization
Organization Name:KNOX COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/ DATA MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-546-9722
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5539
Mailing Address - Country:US
Mailing Address - Phone:606-546-9722
Mailing Address - Fax:606-546-2106
Practice Address - Street 1:14173 N US HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6183
Practice Address - Country:US
Practice Address - Phone:606-546-9722
Practice Address - Fax:606-546-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8038401Medicare PIN