Healthcare Provider Details

I. General information

NPI: 1851390603
Provider Name (Legal Business Name): CASEY CO AMBULANCE TAX BOARD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 CAMPBELLSVILLE ST
LIBERTY KY
42539-3367
US

IV. Provider business mailing address

836 4TH AVE
HUNTINGTON WV
25701-1407
US

V. Phone/Fax

Practice location:
  • Phone: 606-787-8350
  • Fax:
Mailing address:
  • Phone: 800-676-4785
  • Fax: 304-522-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1327
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1327
License Number StateKY

VIII. Authorized Official

Name: MALCOLM MILLER
Title or Position: DIRECTOR
Credential:
Phone: 606-787-8350