1093737355 NPI number — BAKER COUNTY EMERGENCY MEDICAL SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093737355 NPI number — BAKER COUNTY EMERGENCY MEDICAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAKER COUNTY EMERGENCY MEDICAL SERVICE
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:
1093737355
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:
PO BOX 683
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39870-0683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-734-3000
Provider Business Mailing Address Fax Number:
229-734-8822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 HILLCREST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-734-3008
Provider Business Practice Location Address Fax Number:
229-734-8822
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BELINC
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
229-734-3000

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  004-02 , 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)





Copyright © 2007-2025 www.npivalidator.com