Provider Demographics
NPI:1518950971
Name:COUNTY OF CROCKETT
Entity Type:Organization
Organization Name:COUNTY OF CROCKETT
Other - Org Name:CROCKETT COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REASONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-696-5571
Mailing Address - Street 1:872 S CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-3857
Mailing Address - Country:US
Mailing Address - Phone:731-696-5571
Mailing Address - Fax:731-696-2209
Practice Address - Street 1:872 S CAVALIER DR
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-3857
Practice Address - Country:US
Practice Address - Phone:731-696-5571
Practice Address - Fax:731-696-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000017013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9843OtherBCBS OF TN
3524262Medicare ID - Type Unspecified