1144239989 NPI number — CHURCH HILL EMERGENCY MEDICAL SERVICES, INC

Table of content: (NPI 1144239989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144239989 NPI number — CHURCH HILL EMERGENCY MEDICAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHURCH HILL EMERGENCY MEDICAL SERVICES, INC
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:
1144239989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHURCH HILL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37642-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-357-7971
Provider Business Mailing Address Fax Number:
423-357-1376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 W MAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHURCH HILL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37642-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-357-7971
Provider Business Practice Location Address Fax Number:
423-357-1376
Provider Enumeration Date:
08/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARNOLD
Authorized Official First Name:
FRED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-357-6010

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  EMS0000003701 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3558894 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4121187 . This is a "BC OF TN PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 590005976 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".