Provider Demographics
NPI:1205832797
Name:COUNTY OF RUTHERFORD OFFICE OF BUDGET DIRECTOR
Entity Type:Organization
Organization Name:COUNTY OF RUTHERFORD OFFICE OF BUDGET DIRECTOR
Other - Org Name:RUTHERFORD COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-898-7790
Mailing Address - Street 1:611 E. LYTLE ST.
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130
Mailing Address - Country:US
Mailing Address - Phone:615-217-0064
Mailing Address - Fax:615-898-7952
Practice Address - Street 1:611 E LYTLE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3919
Practice Address - Country:US
Practice Address - Phone:615-898-7790
Practice Address - Fax:615-898-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000075013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1401514OtherHEALTHSPRING
TN9852OtherBLUE CROSS OF TN
TN01040561OtherAMERIGROUP COMMUNITY CARE
TN3524565Medicaid
TN590101329OtherRAILROAD MEDICARE
TN590101329OtherRAILROAD MEDICARE
TN9852OtherBLUE CROSS OF TN