Provider Demographics
NPI:1326019480
Name:OVERTON COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:OVERTON COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-823-6402
Mailing Address - Street 1:5900 BRADFORD HICKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-2236
Mailing Address - Country:US
Mailing Address - Phone:931-823-6402
Mailing Address - Fax:931-823-7739
Practice Address - Street 1:5900 BRADFORD HICKS DRIVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-2236
Practice Address - Country:US
Practice Address - Phone:931-823-6402
Practice Address - Fax:931-823-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS0000006702341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2007603Medicaid
TN4115321OtherEMERG TENNCARE AND BCBSTN
TN2007603Medicaid