Provider Demographics
NPI:1891731444
Name:JEFFERSON COUNTY EMERGENCY MEDICAL SERV.
Entity Type:Organization
Organization Name:JEFFERSON COUNTY EMERGENCY MEDICAL SERV.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:865-397-7228
Mailing Address - Street 1:931 INDUSTRIAL PARK RD
Mailing Address - Street 2:PO BOX 1206
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4701
Mailing Address - Country:US
Mailing Address - Phone:865-397-7228
Mailing Address - Fax:865-397-4687
Practice Address - Street 1:911 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4701
Practice Address - Country:US
Practice Address - Phone:865-397-7228
Practice Address - Fax:865-397-4687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000045013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2000161OtherPHP TENNCARE
TN3574818Medicaid
TN4092741OtherCOMMERCIAL BCBS OF TN
TN4088822OtherBLUE CARE/TENNCARE SELECT
TN2000161OtherPHP TENNCARE