1679606040 NPI number — ANGEL EMS LLC

Table of content: (NPI 1679606040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679606040 NPI number — ANGEL EMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL EMS LLC
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:
1679606040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
337 S CEDAR LN
Provider Second Line Business Mailing Address:
PO BOX 5495
Provider Business Mailing Address City Name:
FT OGLETHORPE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30742-3378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-861-1234
Provider Business Mailing Address Fax Number:
706-375-8209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 S CEDAR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT OGLETHORPE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30742-3378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-861-1234
Provider Business Practice Location Address Fax Number:
706-375-8209
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
SHERI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-861-1234

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  023-05 , 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: 52665555 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4002438 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 590012945 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1430581 . This is a "HEALTHSPRING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4582291 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000823259A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81016 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4117030 . This is a "TENN CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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