Healthcare Provider Details

I. General information

NPI: 1497720072
Provider Name (Legal Business Name): ELKHORN AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 BRIDGE STREET
ELKHORN CITY KY
41522
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-5173
  • Fax: 606-754-5813
Mailing address:
  • Phone: 800-676-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1658
License Number StateKY

VIII. Authorized Official

Name: TERRY THOMPSON
Title or Position: CHIEF
Credential:
Phone: 606-754-5173