Provider Demographics
NPI:1609867936
Name:CLAIBORNE COUNTY HOSPITAL AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CLAIBORNE COUNTY HOSPITAL AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-526-2244
Mailing Address - Street 1:1809 OLD KNOXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3632
Mailing Address - Country:US
Mailing Address - Phone:423-526-2244
Mailing Address - Fax:423-626-1742
Practice Address - Street 1:1809 OLD KNOXVILLE RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3632
Practice Address - Country:US
Practice Address - Phone:423-526-2244
Practice Address - Fax:423-626-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000013013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3560307Medicaid
TN003013228OtherBCBS OF TN
TN3560307Medicare UPIN
TN3560307Medicare ID - Type Unspecified