Provider Demographics
NPI:1962478511
Name:CRISP COUNTY EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:CRISP COUNTY EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL AUDITOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-271-9686
Mailing Address - Street 1:PO BOX 5007
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-5007
Mailing Address - Country:US
Mailing Address - Phone:229-271-9686
Mailing Address - Fax:229-271-9689
Practice Address - Street 1:202 A HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-271-9686
Practice Address - Fax:229-271-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110104Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER