Provider Demographics
NPI:1184613267
Name:HENRY COUNTY MEDICAL CENTER EMS INC.
Entity type:Organization
Organization Name:HENRY COUNTY MEDICAL CENTER EMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:731-644-8363
Mailing Address - Street 1:202 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4551
Mailing Address - Country:US
Mailing Address - Phone:731-644-8363
Mailing Address - Fax:731-644-9432
Practice Address - Street 1:202 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4551
Practice Address - Country:US
Practice Address - Phone:731-644-8363
Practice Address - Fax:731-644-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000040013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574780Medicaid
TNP00172305OtherRAILROAD MEDICARE
TN4103624OtherBLUE CROSS BLUE SHIELD IN
TN=========OtherTLC TNCARE
TN3574780Medicaid