Healthcare Provider Details

I. General information

NPI: 1548267727
Provider Name (Legal Business Name): MEDICAL CENTER AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 LAFFOON ST
MADISONVILLE KY
42431-1624
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 270-821-1294
  • Fax: 270-825-9452
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1413
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1413
License Number StateKY

VIII. Authorized Official

Name: JONATHAN LUCK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 270-821-1294