Provider Demographics
NPI:1306895248
Name:STANFORD EMS & RESCUE INC
Entity type:Organization
Organization Name:STANFORD EMS & RESCUE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-365-2957
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
Practice Address - Street 1:1762 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-7801
Practice Address - Country:US
Practice Address - Phone:606-365-2833
Practice Address - Fax:606-365-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000069753OtherBLUE CROSS BLUE SHIELD
KY590002156OtherRAILROAD MEDICARE
KY080016100OtherBLACK LUNG
KY2446955000OtherPASSPORT ADVANTAGE
KY55069041Medicaid
KY56005242Medicaid
KY50005652OtherPASSPORT HEALTH
KY1456611OtherUMWA
KY2446955000OtherPASSPORT ADVANTAGE