=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003845751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOODFORD COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 01/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 86 BIG SINK RD
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-873-8161
-----------------------------------------------------
Fax | 859-873-8057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 86 BIG SINK RD
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40383-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-873-8161
-----------------------------------------------------
Fax | 859-873-8057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | FREEMAN BAILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-873-8161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1275
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------