Provider Demographics
NPI:1942381819
Name:CITY OF MEMPHIS GENERAL CITY GOVT.
Entity Type:Organization
Organization Name:CITY OF MEMPHIS GENERAL CITY GOVT.
Other - Org Name:MEMPHIS FIRE DEPARTMENT EMS BUREAU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHELTON-SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-636-5426
Mailing Address - Street 1:PO BOX 1000 DEPT 939
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0939
Mailing Address - Country:US
Mailing Address - Phone:888-906-6367
Mailing Address - Fax:888-972-9641
Practice Address - Street 1:65 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2498
Practice Address - Country:US
Practice Address - Phone:901-636-5426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000079013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3500457Medicare ID - Type Unspecified