MEDICARE: CITY OF PROVIDENCE OFFICE OF TREASURER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1331	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	631082	OTHER	KY	WELLCARE - MA MCO
2	93147	OTHER	KY	COVENTRY HEALTHCARE - MA MCO
3	000000213260	OTHER	KY	ANTHEM BLUE CROSS
4	086992600	OTHER		FEDERAL BLACK LUNG PROGRAM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	50009902	OTHER	KY	PASSPORT HEALTH - MA MCO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457358632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF PROVIDENCE OFFICE OF TREASURER

Provider Business Mailing Address
First Line	:	PO BOX 589
Second Line	:
City	:	MADISONVILLE
State	:	KY
Zip	:	42431-5011
Country	:	US
Telephone Number	:	270-824-8123
Fax Number	:	270-824-8140

Provider Business Practice Location Address
First Line	:	220 N WILLOW ST
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-1273
Country	:	US
Telephone Number	:	270-667-2011
Fax Number	:	270-667-2012

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. BRAD CURRY
Credential	:
Telephone Number	:	270-667-2011

Provider Enumeration Date	:	07/04/2005
Last Update Date	:	10/24/2014

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Directions to “CITY OF PROVIDENCE OFFICE OF TREASURER ” Practice Location

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