Provider Demographics
NPI:1467706317
Name:PRIORITY CARE AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:PRIORITY CARE AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-585-4444
Mailing Address - Street 1:202 HWY 17N
Mailing Address - Street 2:SUITE C
Mailing Address - City:WRENS
Mailing Address - State:GA
Mailing Address - Zip Code:30833-3829
Mailing Address - Country:US
Mailing Address - Phone:706-547-0840
Mailing Address - Fax:706-547-0845
Practice Address - Street 1:202 HWY 17 N
Practice Address - Street 2:SUITE C
Practice Address - City:WRENS
Practice Address - State:GA
Practice Address - Zip Code:30833-3829
Practice Address - Country:US
Practice Address - Phone:706-547-0840
Practice Address - Fax:706-547-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport