MEDICARE: CARTER CO EMERGENCY AMBULANCE SERVICE DISTRICT

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	341600000X	Ambulance	1174	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	590005372	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497753396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTER CO EMERGENCY AMBULANCE SERVICE DISTRICT

Provider Business Mailing Address
First Line	:	836 4TH AVENUE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701
Country	:	US
Telephone Number	:	800-676-4785
Fax Number	:	304-522-4222

Provider Business Practice Location Address
First Line	:	12 CROSSBAR RD
Second Line	:
City	:	GRAYSON
State	:	KY
Zip	:	41143-1551
Country	:	US
Telephone Number	:	606-474-8181
Fax Number	:	606-474-0529

Authorized Official
Title or Position	:	CHIEF
Name	:	JERRY HORN
Credential	:
Telephone Number	:	606-474-8181

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/03/2013

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Directions to “CARTER CO EMERGENCY AMBULANCE SERVICE DISTRICT ” Practice Location

Language	Start Address	Practice Location

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