MEDICARE: CITY OF FORT MITCHELL OFFICE OF TREASURER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000001199826	OTHER	KY	CHA
3	000000039205	OTHER	KY	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780683532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF FORT MITCHELL OFFICE OF TREASURER

Provider Business Mailing Address
First Line	:	PO BOX 9150
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42002-9150
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-8642

Provider Business Practice Location Address
First Line	:	2355 DIXIE HWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2948
Country	:	US
Telephone Number	:	859-331-1267
Fax Number	:	859-331-6102

Authorized Official
Title or Position	:	CHIEF
Name	:	ADAM L FULLER
Credential	:
Telephone Number	:	859-331-1267

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/12/2021

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