Provider Demographics
NPI:1881693638
Name:ESTILL COUNTY EMS
Entity type:Organization
Organization Name:ESTILL COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUNCIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-723-2124
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:304-521-1576
Practice Address - Street 1:22 MERCY COURT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-9998
Practice Address - Country:US
Practice Address - Phone:606-723-2124
Practice Address - Fax:304-521-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1143774OtherPASSPORT
KY406590715OtherRR MEDICARE
KY000000070069OtherANTHEM
KY083445300OtherBLACK LUNG
KY55033013Medicaid
KY56003916Medicaid