Organization
JOHNSON LIFE CARE, INC
Active
Other names
Johnson Life Care Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARREL VANOVER EMT (OWNER)
(606) 848-2861
Entity
Organization
Contact information
Practice address
310 WEST MAIN STREET, LYNCH, KY 40855
(606) 848-2861
(606) 848-2409
Mailing address
PO BOX 728, LYNCH, KY 40855-0728
(606) 848-2861
(606) 848-2409
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1609
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000070292
BLUE CROSS BLUE SHIELD
KY
05
—
010121078
—
VA
01
—
089589600
BLACK LUNG
KY
01
—
1416591
UNITED MINE WORKERS
KY
05
—
4582350
—
TN
01
—
50011660
PASSPORT HEALTH
KY
05
—
55048078
—
KY
05
—
56004179
—
KY
01
—
590011400
RAILROAD MEDICARE
KY
Enumeration date
04/21/2006
Last updated
11/04/2011
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