Healthcare Provider Details

I. General information

NPI: 1548244866
Provider Name (Legal Business Name): RUSSELL CO AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 FERCO WAY
JAMESTOWN KY
42629-2438
US

IV. Provider business mailing address

108 FERCO WAY
JAMESTOWN KY
42629-2438
US

V. Phone/Fax

Practice location:
  • Phone: 270-343-6464
  • Fax: 270-343-6462
Mailing address:
  • Phone: 270-343-6464
  • Fax: 270-343-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1484
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY HANCOCK
Title or Position: DIRECTOR
Credential:
Phone: 270-343-6464