Provider Demographics
NPI:1740261981
Name:VAN BUREN COUNTY COURTHOUSE SQ
Entity type:Organization
Organization Name:VAN BUREN COUNTY COURTHOUSE SQ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIWANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:931-946-8181
Mailing Address - Street 1:112 GENERATIONS DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:TN
Mailing Address - Zip Code:38585-3027
Mailing Address - Country:US
Mailing Address - Phone:931-946-8181
Mailing Address - Fax:931-946-8182
Practice Address - Street 1:112 GENERATIONS DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:TN
Practice Address - Zip Code:38585-3027
Practice Address - Country:US
Practice Address - Phone:931-946-8181
Practice Address - Fax:931-946-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-06
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000099963416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4121233OtherBCBS EMERGENCY
TN3129083OtherBCBS NON-EMERGENCY
TN3129083OtherBCBS NON-EMERGENCY