Provider Demographics
NPI:1629069430
Name:GREENE COUNTY GREENEVILLE EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:GREENE COUNTY GREENEVILLE EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-798-1720
Mailing Address - Street 1:1027 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4611
Mailing Address - Country:US
Mailing Address - Phone:423-798-1720
Mailing Address - Fax:423-798-1721
Practice Address - Street 1:1027 FOREST ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4611
Practice Address - Country:US
Practice Address - Phone:423-798-1720
Practice Address - Fax:423-798-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000030013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4120193OtherBLUE CROSS BLUE SHIELD
TN100021810Medicaid
TN590080315Medicare PIN
TN3526619Medicare PIN