Provider Demographics
NPI:1780335893
Name:CORP. OF COLLIERVILLE
Entity type:Organization
Organization Name:CORP. OF COLLIERVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:901-457-2483
Mailing Address - Street 1:1251 PETERSON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1172
Mailing Address - Country:US
Mailing Address - Phone:901-910-7618
Mailing Address - Fax:901-457-2492
Practice Address - Street 1:1251 PETERSON LAKE RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1172
Practice Address - Country:US
Practice Address - Phone:901-910-7618
Practice Address - Fax:901-457-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport