City of Mayfield Office of City Clerk
Organization Active NPI Land Ambulance · Mayfield, KY
NPI 1902803182 · NPPES record last updated Feb 22, 2018
Key facts
- NPI
- 1902803182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 1009 (KY)
- Legal business name
- CITY OF MAYFIELD OFFICE OF CITY CLERK
- Practice address
- 104 N 6TH St
Mayfield, KY 42066-1602 - Phone
- (270) 251-6248
- Fax
- (270) 251-9888
- NPI assigned
- Jul 4, 2005
- Organization subpart
- No
Authorized official
- Name
- Jeremy Creason
- Title
- Director
- Phone
- (270) 251-6240
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040519000111 | KY | Part B Supplier - Ambulance Service Supplier | 4284625393 | Practice locations: Mayfield, KY |
National Provider Directory
Locations
1001 S 10th St
Mayfield, KY 42066
Phone (270) 247-8017
1001 W Broadway
Mayfield, KY 42066
Phone (270) 247-6135
104 N 6th St
Mayfield, KY 42066
Phone (270) 251-6248
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 1009 | KY | Yes |
Addresses
Primary practice location
104 N 6TH St
Mayfield, KY 42066-1602
Mailing address
PO Box 589
Madisonville, KY 42431-5011
Phone (270) 824-8123
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56004286 | Medicaid | KY | |
| 55042014 | Medicaid | KY | |
| 406590071 | Other | RR MEDICARE |
Other providers in Mayfield, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.