Provider Demographics
NPI:1770533176
Name:MEDSTAT EMS INC
Entity type:Organization
Organization Name:MEDSTAT EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 198408
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8408
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:330-384-4019
Practice Address - Street 1:506 N APPLEGATE ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-1829
Practice Address - Country:US
Practice Address - Phone:662-283-8905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
MS244341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
613087800OtherUS DOL
TN1514438Medicaid
MS00550460Medicaid
613087800OtherUS DOL
=========OtherTRICARE