Provider Demographics
NPI:1770253684
Name:PURPLE HEARTS EMS, LLC
Entity Type:Organization
Organization Name:PURPLE HEARTS EMS, LLC
Other - Org Name:PURPLE HEARTS EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-978-4855
Mailing Address - Street 1:1700 PENNSYLVANIA AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9115
Mailing Address - Country:US
Mailing Address - Phone:678-978-4855
Mailing Address - Fax:
Practice Address - Street 1:1700 PENNSYLVANIA AVE STE 109
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9115
Practice Address - Country:US
Practice Address - Phone:678-978-4855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770253684OtherNPI