Provider Demographics
NPI:1326026394
Name:COUNTY OF FAYETTE
Entity Type:Organization
Organization Name:COUNTY OF FAYETTE
Other - Org Name:FAYETTE COUNTY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:V
Authorized Official - Last Name:TAYOR
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:901-465-3126
Mailing Address - Street 1:102 EAST LATTA LANE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068
Mailing Address - Country:US
Mailing Address - Phone:901-465-3126
Mailing Address - Fax:901-465-7725
Practice Address - Street 1:102 EAST LATTA LANE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068
Practice Address - Country:US
Practice Address - Phone:901-465-3126
Practice Address - Fax:901-465-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS 000000 2401341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574521Medicare ID - Type Unspecified