Provider Demographics
NPI:1801929005
Name:PERRY COUNTY AMBULANCE AUTHORITY, INC.
Entity type:Organization
Organization Name:PERRY COUNTY AMBULANCE AUTHORITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:STACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-439-4776
Mailing Address - Street 1:22 TERRANCE VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701
Mailing Address - Country:US
Mailing Address - Phone:606-439-4776
Mailing Address - Fax:606-439-4776
Practice Address - Street 1:22 TERRANCE VIEW DR.
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-4776
Practice Address - Fax:606-439-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55097034Medicaid
KY407540578OtherRAILROAD MEDICARE
KY0832278OtherUMWA
KY56004633Medicaid
KY407540578OtherRAILROAD MEDICARE