Provider Demographics
NPI:1073615407
Name:EVANS COUNTY EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:EVANS COUNTY EMERGENCY MEDICAL SERVICE
Other - Org Name:EVANS COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-732-1001
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-0284
Mailing Address - Country:US
Mailing Address - Phone:912-732-1001
Mailing Address - Fax:912-732-1000
Practice Address - Street 1:405 E LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1443
Practice Address - Country:US
Practice Address - Phone:912-732-1001
Practice Address - Fax:912-732-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002637A4Medicaid