1427043702 NPI number — MORRISTOWN HAMBLEN EMERGENCY MEDICAL SERVICES

Table of content: (NPI 1427043702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427043702 NPI number — MORRISTOWN HAMBLEN EMERGENCY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRISTOWN HAMBLEN EMERGENCY MEDICAL SERVICES
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:
Provider Other Organization Name Type Code:
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:
1427043702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 N JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37814-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-587-3280
Provider Business Mailing Address Fax Number:
423-585-2729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 N JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-587-3280
Provider Business Practice Location Address Fax Number:
423-585-2729
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOUSERIGHT
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
423-587-3280

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS0000003201 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100021850 . This is a "PHP TENN CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 40970 . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1000 . This is a "ACORDIA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 230909800 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3547490 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9128387 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 087480100 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 590014954 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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