Provider Demographics
NPI:1164412490
Name:SEVIER COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SEVIER COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-453-3248
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-8413
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:718 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5019
Practice Address - Country:US
Practice Address - Phone:865-453-3248
Practice Address - Fax:865-453-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100020918OtherPHP TENNCARE ID #
KY246638OtherANTHEM BC ID #
TN702002153OtherCARITEN ID #
TN4110001OtherBLUE CROSS OF TN ID #
TN9637OtherBLUE CROSS ID #
TN3524914Medicaid
TN3524914Medicare ID - Type UnspecifiedPROVIDER NUMBER
TN3524914Medicaid