Healthcare Provider Details

I. General information

NPI: 1104481092
Provider Name (Legal Business Name): BREATHITT-WOLFE EMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOWELL LN
JACKSON KY
41339-8657
US

IV. Provider business mailing address

PO BOX 589
MADISONVILLE KY
42431-5011
US

V. Phone/Fax

Practice location:
  • Phone: 606-666-4444
  • 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 Number
License Number State

VIII. Authorized Official

Name: JARRED FANNIN
Title or Position: OWNER
Credential:
Phone: 606-548-0960