Provider Demographics
NPI:1164454617
Name:REGIONAL EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:REGIONAL EMERGENCY MEDICAL SERVICES
Other - Org Name:REGIONAL EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-263-4005
Mailing Address - Street 1:PO BOX 5677
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-5677
Mailing Address - Country:US
Mailing Address - Phone:229-263-4005
Mailing Address - Fax:229-263-7741
Practice Address - Street 1:300 S MADISON ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-2752
Practice Address - Country:US
Practice Address - Phone:229-263-4005
Practice Address - Fax:229-263-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014-03341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00848306AMedicaid
GA59RCBKPMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER