Provider Demographics
NPI:1417061136
Name:MONROE COUNTY AMBULANCE SERVICE
Entity type:Organization
Organization Name:MONROE COUNTY AMBULANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-442-4063
Mailing Address - Street 1:310 TELLICO ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354
Mailing Address - Country:US
Mailing Address - Phone:423-442-4063
Mailing Address - Fax:423-442-8089
Practice Address - Street 1:210 LEWIS ST.
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1515
Practice Address - Country:US
Practice Address - Phone:423-442-4063
Practice Address - Fax:423-442-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000062013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0009850OtherBCBSTN
TN180486Medicaid
TN800157OtherFEDBLACKLUNGPROGRAM
TN590080330OtherRR MEDICARE
TN3526453Medicare PIN