Provider Demographics
NPI:1710980347
Name:BRACKEN COUNTY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:BRACKEN COUNTY AMBULANCE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-735-3783
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:304-521-1576
Practice Address - Street 1:592 BLADESTON DRIVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41004-8123
Practice Address - Country:US
Practice Address - Phone:606-735-3783
Practice Address - Fax:606-735-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11453416L0300X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00652148OtherRAILROAD MEDICARE
TX170660801Medicaid
KY55012017Medicaid
KY000000070024OtherBCBS OF KENTUCKY
OH2504132Medicaid
KY56003551Medicaid
KY590587008OtherRAILROAD MEDICARE