Provider Demographics
NPI:1578652590
Name:TALBOT COUNTY COMMISSIONER OF ROADS & REVENUES
Entity Type:Organization
Organization Name:TALBOT COUNTY COMMISSIONER OF ROADS & REVENUES
Other - Org Name:TALBOT COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-665-3220
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:TALBOTTON
Mailing Address - State:GA
Mailing Address - Zip Code:31827-0115
Mailing Address - Country:US
Mailing Address - Phone:706-665-3456
Mailing Address - Fax:706-665-2317
Practice Address - Street 1:1853 GENEVA HWY
Practice Address - Street 2:
Practice Address - City:TALBOTTON
Practice Address - State:GA
Practice Address - Zip Code:31827-8542
Practice Address - Country:US
Practice Address - Phone:706-665-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA130-043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000379211AMedicaid
GA85053059AAMedicare UPIN