1164445391 NPI number — GOLD CROSS EMS, INC.

Table of content: (NPI 1164445391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164445391 NPI number — GOLD CROSS EMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLD CROSS EMS, 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:
1164445391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 14848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30919-0848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-434-4000
Provider Business Mailing Address Fax Number:
706-504-9521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4328 WHEELER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30907-9740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-434-4000
Provider Business Practice Location Address Fax Number:
706-396-2100
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STORY
Authorized Official First Name:
CAREY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
706-434-4018

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 121-08 , 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: 590012255 . This is a "RR-MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000781558A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590012255 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010271300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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