Provider Demographics
NPI:1205820651
Name:PIERCE COUNTY COMMISSIONER OF ROADS AND REVENUES
Entity Type:Organization
Organization Name:PIERCE COUNTY COMMISSIONER OF ROADS AND REVENUES
Other - Org Name:PIERCE COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-816-9203
Mailing Address - Street 1:312 NICHOLS ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1926
Mailing Address - Country:US
Mailing Address - Phone:912-449-2002
Mailing Address - Fax:912-480-9700
Practice Address - Street 1:253 E CARTER AVE
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1545
Practice Address - Country:US
Practice Address - Phone:124-492-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001515BMedicaid
GA85051559AAMedicare ID - Type Unspecified