Provider Demographics
NPI:1689679193
Name:EMERGENCY MOBILE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:EMERGENCY MOBILE HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELBERT
Authorized Official - Middle Name:O'NEAL
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:901-271-5024
Mailing Address - Street 1:PO BOX 382550
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-2550
Mailing Address - Country:US
Mailing Address - Phone:901-818-0911
Mailing Address - Fax:901-377-1599
Practice Address - Street 1:6972 APPLING FARMS PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4725
Practice Address - Country:US
Practice Address - Phone:901-818-0911
Practice Address - Fax:901-377-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS0000009975341600000X
MS315341600000X
TN101753416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3572241Medicaid
MS03633306Medicaid
AR138418715Medicaid
TN3572241Medicare PIN