Healthcare Provider Details

I. General information

NPI: 1932166758
Provider Name (Legal Business Name): GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DAKOTA MEYER DR
GREENSBURG KY
42743-1451
US

IV. Provider business mailing address

PO BOX 589
MADISONVILLE KY
42431-5011
US

V. Phone/Fax

Practice location:
  • Phone: 270-932-7414
  • Fax:
Mailing address:
  • Phone: 270-824-8123
  • Fax: 270-824-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1467
License Number StateKY

VIII. Authorized Official

Name: MR. NICK CHEATHAM
Title or Position: DIRECTOR
Credential:
Phone: 270-932-7414