Provider Demographics
NPI:1144207176
Name:COUNTY OF SEQUATCHIE OFFICE
Entity Type:Organization
Organization Name:COUNTY OF SEQUATCHIE OFFICE
Other - Org Name:SEQUATCHIE COUNTY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNTY EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-949-3479
Mailing Address - Street 1:P.O. BOX 1584
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-1584
Mailing Address - Country:US
Mailing Address - Phone:423-949-5688
Mailing Address - Fax:423-949-5710
Practice Address - Street 1:723 RANKIN AVE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7745
Practice Address - Country:US
Practice Address - Phone:423-947-5688
Practice Address - Fax:423-949-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000099573416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574558Medicare PIN
3574558Medicare PIN