Healthcare Provider Details

I. General information

NPI: 1013958164
Provider Name (Legal Business Name): ELLIOTT COUNTY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 AMBULANCE RD
SANDY HOOK KY
41171
US

IV. Provider business mailing address

PO BOX 589
MADISONVILLE KY
42431-5011
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-4132
  • Fax: 606-738-6667
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 Number1178
License Number StateKY

VIII. Authorized Official

Name: MICHAEL BURLING
Title or Position: DIRECTOR
Credential:
Phone: 606-484-1060