Provider Demographics
NPI:1053316265
Name:COUNTY OF MONTGOMERY-OFFICE OF COUNTY JUDGE
Entity Type:Organization
Organization Name:COUNTY OF MONTGOMERY-OFFICE OF COUNTY JUDGE
Other - Org Name:MONTGOMERY COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-920-1800
Mailing Address - Street 1:601 DUNLOP LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5015
Mailing Address - Country:US
Mailing Address - Phone:931-920-1800
Mailing Address - Fax:931-645-5702
Practice Address - Street 1:601 DUNLOP LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5015
Practice Address - Country:US
Practice Address - Phone:931-920-1800
Practice Address - Fax:931-645-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000063013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3514481Medicare ID - Type UnspecifiedMEDICARE NUMBER