MEDICARE: KNOX EMERGENCY SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DC4085	OTHER	OH	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000209488	OTHER	OH	BLUE CROSS & BLUE SHIELD
2	562272748	OTHER	OH	CHAMPUS
4	154184200	OTHER	OH	DEPT OF LABOR
5	154184200	OTHER	OH	FL BLACK LUNG
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861450066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOX EMERGENCY SERVICES, LLC

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1558 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-5416
Country	:	US
Telephone Number	:	740-393-9000
Fax Number	:	904-805-1302

Authorized Official
Title or Position	:	VP OF CONTRACTING
Name	:	LISHA C FALK
Credential	:
Telephone Number	:	337-609-1221

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/23/2022

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Directions to “KNOX EMERGENCY SERVICES, LLC ” Practice Location

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