Provider Demographics
NPI:1750514196
Name:EMPACT AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:EMPACT AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-971-0663
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-0788
Mailing Address - Country:US
Mailing Address - Phone:615-223-5995
Mailing Address - Fax:615-223-5651
Practice Address - Street 1:109 THREET INDUSTRIAL RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6842
Practice Address - Country:US
Practice Address - Phone:615-223-5995
Practice Address - Fax:615-223-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517864Medicaid
TN1517864Medicaid