Healthcare Provider Details

I. General information

NPI: 1588896260
Provider Name (Legal Business Name): JAKES BRANCH FIRE AND RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5447 KY HWY 476
BULAN KY
41722-0065
US

IV. Provider business mailing address

PO BOX 65
BULAN KY
41722-0065
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-4431
  • Fax: 606-439-4431
Mailing address:
  • Phone: 606-439-4431
  • Fax: 606-439-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP0901013
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB1638227
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number45390
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number155970101
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number5666813
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP0921975
License Number StateKY

VIII. Authorized Official

Name: MR. KENNETH BROWNING II
Title or Position: FIRE CHIEF
Credential:
Phone: 606-439-4431