Provider Demographics
NPI:1982836581
Name:UNITED MEDICAL RESPONSE LLC
Entity Type:Organization
Organization Name:UNITED MEDICAL RESPONSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:ISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-866-2120
Mailing Address - Street 1:515 E CROSSVILLE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3087
Mailing Address - Country:US
Mailing Address - Phone:770-299-1516
Mailing Address - Fax:770-299-1518
Practice Address - Street 1:2425 JASON INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:GA
Practice Address - Zip Code:30187
Practice Address - Country:US
Practice Address - Phone:770-672-6434
Practice Address - Fax:205-993-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport