Provider Demographics
NPI:1518732643
Name:SOUTHERN REGIONAL EMS LLC
Entity Type:Organization
Organization Name:SOUTHERN REGIONAL EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-515-3119
Mailing Address - Street 1:1640 ABERDEEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8636
Mailing Address - Country:US
Mailing Address - Phone:727-515-3119
Mailing Address - Fax:
Practice Address - Street 1:215 S CULPEPPER ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-2707
Practice Address - Country:US
Practice Address - Phone:727-515-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance