Provider Demographics
NPI:1295831477
Name:CITY OF KINGSLAND
Entity Type:Organization
Organization Name:CITY OF KINGSLAND
Other - Org Name:KINGSLAND FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-729-5613
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-0250
Mailing Address - Country:US
Mailing Address - Phone:912-729-5613
Mailing Address - Fax:912-729-8827
Practice Address - Street 1:105 WEST WILLIAMS AVENUE
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548
Practice Address - Country:US
Practice Address - Phone:912-729-5613
Practice Address - Fax:912-729-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000933171AMedicaid
GA59RCBLDMedicare ID - Type Unspecified