Provider Demographics
NPI:1609087055
Name:EAGLE MEDICAL SERVICE EMS LLC
Entity Type:Organization
Organization Name:EAGLE MEDICAL SERVICE EMS LLC
Other - Org Name:EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:901-386-4552
Mailing Address - Street 1:1710 BARCREST DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-6404
Mailing Address - Country:US
Mailing Address - Phone:901-377-7000
Mailing Address - Fax:
Practice Address - Street 1:1710 BARCREST DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-6404
Practice Address - Country:US
Practice Address - Phone:901-377-7000
Practice Address - Fax:901-382-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7920341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance