Provider Demographics
NPI:1427410208
Name:BLUE CROSS EMS LLC
Entity Type:Organization
Organization Name:BLUE CROSS EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-520-9009
Mailing Address - Street 1:3 PINE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2561
Mailing Address - Country:US
Mailing Address - Phone:404-520-9009
Mailing Address - Fax:678-782-3222
Practice Address - Street 1:3 PINE GROVE DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-2561
Practice Address - Country:US
Practice Address - Phone:404-520-9009
Practice Address - Fax:678-782-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMB20160053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport