Provider Demographics
NPI:1841200441
Name:MCINTOSH COUNTY COMMISSIONERS OF ROADS & REVENUE
Entity Type:Organization
Organization Name:MCINTOSH COUNTY COMMISSIONERS OF ROADS & REVENUE
Other - Org Name:MCINTOSH COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-437-6671
Mailing Address - Street 1:20855 KENSINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7542
Mailing Address - Country:US
Mailing Address - Phone:952-469-1589
Mailing Address - Fax:952-985-5671
Practice Address - Street 1:1019 PRODUCTION ROW SW
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-6151
Practice Address - Country:US
Practice Address - Phone:912-832-6265
Practice Address - Fax:952-985-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA098-03341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00327225AMedicaid
GA00327225AMedicaid