Provider Demographics
NPI:1225100589
Name:MARION COUNTY COMMISSIONER OF ROADS AND REVENUE
Entity Type:Organization
Organization Name:MARION COUNTY COMMISSIONER OF ROADS AND REVENUE
Other - Org Name:MARION COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEJONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-314-4569
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:GA
Mailing Address - Zip Code:31803-0702
Mailing Address - Country:US
Mailing Address - Phone:229-649-3025
Mailing Address - Fax:229-649-2033
Practice Address - Street 1:100 BURKHALTER AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:GA
Practice Address - Zip Code:31803-9701
Practice Address - Country:US
Practice Address - Phone:229-314-4569
Practice Address - Fax:229-649-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA096-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000493435AMedicaid
GA590007352OtherRAILROAD MEDCARE
GA59RCBFRMedicare PIN