1982755138 NPI number — JACKSON COUNTY B O C

Table of content: (NPI 1982755138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982755138 NPI number — JACKSON COUNTY B O C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON COUNTY B O C
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:
JACKSON COUNTY EMERGENCY SERVICES
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:
1982755138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936418
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31193-6418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-810-5005
Provider Business Mailing Address Fax Number:
888-965-4620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 GORDON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30549-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-810-5005
Provider Business Practice Location Address Fax Number:
888-965-4620
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
706-367-6356

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  078-02 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000055976A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: NH540 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 590603182 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 191662 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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