Provider Demographics
NPI:1528251915
Name:PREMIERE EMS, LLC.
Entity type:Organization
Organization Name:PREMIERE EMS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:SHURLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-445-8177
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:620 WEST MEMORIAL DRIVE SUITE F
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0021
Mailing Address - Country:US
Mailing Address - Phone:770-445-8177
Mailing Address - Fax:770-445-8160
Practice Address - Street 1:620 W MEMORIAL DR
Practice Address - Street 2:SUITE F
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-3440
Practice Address - Country:US
Practice Address - Phone:770-445-8177
Practice Address - Fax:770-445-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11008343900000X
GA110-083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G590002OtherMEDICARE PART B
GA307141905AMedicaid