MEDICARE: LEE COUNTY FISCAL COURT

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	341600000X	Ambulance	1202	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590587046	OTHER	KY	RAILROAD MEDICARE ID NO.

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000070476	OTHER	KY	ANTHEM BC BS
3	000000070476	OTHER	KY	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841273257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE COUNTY FISCAL COURT

Provider Business Mailing Address
First Line	:	836 4TH AVENUE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1407
Country	:	US
Telephone Number	:	304-521-1576
Fax Number	:	304-521-1768

Provider Business Practice Location Address
First Line	:	18 WALNUT STREET
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311
Country	:	US
Telephone Number	:	606-464-9288
Fax Number	:	606-464-4145

Authorized Official
Title or Position	:	PROVIDER RELATIONS SPECIALIST
Name	:	MIKE WHEELER
Credential	:
Telephone Number	:	304-521-1576

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	04/04/2012

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Directions to “LEE COUNTY FISCAL COURT ” Practice Location

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