Provider Demographics
NPI:1942247507
Name:EXTENDED MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:EXTENDED MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-299-1234
Mailing Address - Street 1:5300 MEMORIAL DR
Mailing Address - Street 2:224-E
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3148
Mailing Address - Country:US
Mailing Address - Phone:404-299-1234
Mailing Address - Fax:404-299-9297
Practice Address - Street 1:5300 MEMORIAL DR
Practice Address - Street 2:224-E
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3148
Practice Address - Country:US
Practice Address - Phone:404-299-1234
Practice Address - Fax:404-299-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMCA500109343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4136150002Medicare ID - Type Unspecified