Provider Demographics
NPI:1508097296
Name:RED GROUP LLC
Entity Type:Organization
Organization Name:RED GROUP LLC
Other - Org Name:UNITED AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:ISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-866-2120
Mailing Address - Street 1:3660 SHOPE RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-3267
Mailing Address - Country:US
Mailing Address - Phone:770-866-2120
Mailing Address - Fax:
Practice Address - Street 1:5292 OAKDALE RD SE
Practice Address - Street 2:SUITE 7
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5245
Practice Address - Country:US
Practice Address - Phone:770-866-2120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport