Provider Demographics
NPI:1174552335
Name:CITY OF DRY RIDGE KENTUCKY
Entity type:Organization
Organization Name:CITY OF DRY RIDGE KENTUCKY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVE
Authorized Official - Suffix:
Authorized Official - Credentials:FIRE FIGHTER PARAMED
Authorized Official - Phone:859-824-9158
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:
Practice Address - Street 1:31 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035
Practice Address - Country:US
Practice Address - Phone:859-824-9158
Practice Address - Fax:859-824-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546856Medicaid
MI4718020Medicaid
KY590014599OtherRAILROAD MEDICARE
KY2443269000OtherPASSPORT ADVANTAGE
KY000000216660OtherBLUE CROSS BLUE SHIELD
TN4582348Medicaid
KY50001700OtherPASSPORT HEALTH
KY55000343Medicaid
KY000000216660OtherBLUE CROSS BLUE SHIELD