Provider Demographics
NPI:1578555801
Name:COLUMBIA COUNTY EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:COLUMBIA COUNTY EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-752-8787
Mailing Address - Street 1:263 NW LAKE CITY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4820
Mailing Address - Country:US
Mailing Address - Phone:386-752-8787
Mailing Address - Fax:386-719-7498
Practice Address - Street 1:263 NW LAKE CITY AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4820
Practice Address - Country:US
Practice Address - Phone:386-752-8787
Practice Address - Fax:386-719-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24653416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA0623Medicare ID - Type UnspecifiedPROVIDER NUMBER