Provider Demographics
NPI:1033182704
Name:SMITH COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SMITH COUNTY AMBULANCE SERVICE
Other - Org Name:SMITH COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-735-2121
Mailing Address - Street 1:303 HIGH ST N
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1429
Mailing Address - Country:US
Mailing Address - Phone:615-735-6232
Mailing Address - Fax:615-735-9712
Practice Address - Street 1:303 HIGH ST N
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1429
Practice Address - Country:US
Practice Address - Phone:615-735-6232
Practice Address - Fax:615-735-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000080013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3500934Medicaid
TN4110219OtherBLUECROSS BLUESHIELD
TN2003290OtherTENNCARE SELECT
TN3500934Medicaid