Organization
LYON COUNTY EMERGENCY AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WIGGINS (EMS DIRECTOR)
(270) 388-7167
Entity
Organization
Contact information
Practice address
236 COMMERCE STREET, EDDYVILLE, KY 42038-8294
(270) 388-7167
(270) 388-7588
Mailing address
236 COMMERCE ST, EDDYVILLE, KY 42038-8294
(270) 388-7167
(270) 388-7588
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1368
KY
3416L0300X
Land Ambulance
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221435
ANTHEM BLUE CROSS
KY
01
—
310933801
FEDERAL BLACK LUNG PROGRAM
—
05
—
55072011
—
KY
05
—
56004245
—
KY
01
—
590013090
RR MEDICARE
—
Enumeration date
07/05/2005
Last updated
02/02/2023
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