1982836581 NPI number — UNITED MEDICAL RESPONSE LLC

Table of content: (NPI 1982836581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982836581 NPI number — UNITED MEDICAL RESPONSE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED MEDICAL RESPONSE 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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982836581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 E CROSSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30075-3087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-299-1516
Provider Business Mailing Address Fax Number:
770-299-1518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 JASON INDUSTRIAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-672-6434
Provider Business Practice Location Address Fax Number:
205-993-4090
Provider Enumeration Date:
08/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ISHAM
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
DERRICK
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
770-866-2120

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , 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)