Provider Demographics
NPI:1932166758
Name:GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT
Entity type:Organization
Organization Name:GREEN COUNTY AMBULANCE SERVICE TAXING DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-932-7414
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 1:55 DAKOTA MEYER DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1451
Practice Address - Country:US
Practice Address - Phone:270-932-7414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY709849300OtherDOL - FECA / BL/ ENERGY
KY1068230OtherPASSPORT HEALTH
KY55044028Medicaid
KY56004005Medicaid
KY000000070265OtherBLUE CROSS BLUE SHIELD
KY2434679000OtherPASSPORT ADVANTAGE
KY56004005Medicaid
KY55044028Medicaid