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General NPI Number Information
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NPI Number | 1659411502
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Entity Type | Organization
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Legal Business Name | FIRST RESPONSE AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 209 DEPOT RD
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1413
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Country | US
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Telephone | 606-886-9845
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Fax | 606-886-0834
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Provider Business Mailing Address
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Address Line | 171 ABBOTT CREEK ROAD STE 1
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City | PRESTONSBURG
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State | KY
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Zip | 41653-0171
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Country | US
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Telephone | 606-886-9845
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Fax | 606-886-0834
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEVIN FAIRLIE
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Credential |
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Telephone | 314-489-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1607
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License Number State | KY
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