Healthcare Provider Details

I. General information

NPI: 1649277823
Provider Name (Legal Business Name): CITY OF HICKMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MOSCOW AVE
HICKMAN KY
42050-1401
US

IV. Provider business mailing address

PO BOX 589
MADISONVILLE KY
42431-0012
US

V. Phone/Fax

Practice location:
  • Phone: 270-236-2535
  • 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 Number1008
License Number StateKY

VIII. Authorized Official

Name: BILL MURRAY
Title or Position: DIRECTOR
Credential:
Phone: 270-236-2535