MEDICARE: EDMONSON COUNTY AMBULANCE 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	3416L0300X	Land Ambulance	1519	KY

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	000000077051	OTHER	KY	ANTHEM BC/BS
3	163544600	OTHER	KY	U.S. DEPT. OF LABOR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891877353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMONSON COUNTY AMBULANCE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 118
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-0118
Country	:	US
Telephone Number	:	270-597-3721
Fax Number	:	270-597-9851

Provider Business Practice Location Address
First Line	:	1755 HWY 259 N.
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-0118
Country	:	US
Telephone Number	:	270-597-3721
Fax Number	:	270-597-9851

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. KEITH SANDERS
Credential	:	PARAMEDIC
Telephone Number	:	270-597-3721

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	12/22/2010

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Directions to “EDMONSON COUNTY AMBULANCE DISTRICT ” Practice Location

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