Provider Demographics
NPI:1588894984
Name:SOUTHEAST AMBULANCE, INC.
Entity type:Organization
Organization Name:SOUTHEAST AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-202-4038
Mailing Address - Street 1:PO BOX 6241
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-6241
Mailing Address - Country:US
Mailing Address - Phone:706-425-8884
Mailing Address - Fax:706-425-8818
Practice Address - Street 1:121 ATHENS WEST PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6942
Practice Address - Country:US
Practice Address - Phone:706-425-8884
Practice Address - Fax:706-613-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport