Provider Demographics
NPI:1649261983
Name:PICKETT COUNTY GOVERMENT
Entity type:Organization
Organization Name:PICKETT COUNTY GOVERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-IV
Authorized Official - Phone:931-864-3182
Mailing Address - Street 1:8817 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-6003
Mailing Address - Country:US
Mailing Address - Phone:931-864-3182
Mailing Address - Fax:931-864-6062
Practice Address - Street 1:8817 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:BYRDSTOWN
Practice Address - State:TN
Practice Address - Zip Code:38549-6003
Practice Address - Country:US
Practice Address - Phone:931-864-3182
Practice Address - Fax:931-864-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000069023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0073894OtherBCBS
TN181886Medicaid
TN181886Medicaid