1821071697 NPI number — JOHNSON COUNTY RESCUE SQUAD EMS

Table of content: (NPI 1821071697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821071697 NPI number — JOHNSON COUNTY RESCUE SQUAD EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON COUNTY RESCUE SQUAD EMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOHNSON COUNTY EMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821071697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 VANDILLA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37683-1837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-727-6531
Provider Business Mailing Address Fax Number:
423-727-6932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 VANDILLA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37683-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-727-6531
Provider Business Practice Location Address Fax Number:
423-727-6932
Provider Enumeration Date:
11/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
423-727-6531

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS4602 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3560765 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".