1831231216 NPI number — IRWIN COUNTY EMS

Table of content: (NPI 1831231216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831231216 NPI number — IRWIN COUNTY EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRWIN COUNTY EMS
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:
1831231216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCILLA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31774-0501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-468-9594
Provider Business Mailing Address Fax Number:
229-468-9673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 COTTON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCILLA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31774-0501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-468-9594
Provider Business Practice Location Address Fax Number:
229-468-9673
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
229-468-9594

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  077-01 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590014503 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000153205A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 198047 . This is a "BCBS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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