Provider Demographics
NPI:1154320687
Name:SULLIVAN COUNTY EMS
Entity type:Organization
Organization Name:SULLIVAN COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-323-6474
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617
Mailing Address - Country:US
Mailing Address - Phone:423-323-6474
Mailing Address - Fax:423-279-2813
Practice Address - Street 1:3193 HIGHWAY 126
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-323-6471
Practice Address - Fax:423-279-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS0000008201341600000X
TN341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3520413Medicaid
TN002007565Medicaid
TN100021464Medicaid
TN3520413Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TN590080191Medicare ID - Type UnspecifiedRR MEDICARE PROV#