Provider Demographics
NPI:1801884275
Name:CITY OF BRISTOL
Entity type:Organization
Organization Name:CITY OF BRISTOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-989-5503
Mailing Address - Street 1:PO BOX 1000, DEPT #15
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:888-466-7964
Mailing Address - Fax:614-987-1989
Practice Address - Street 1:211 BLUFF CITY HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4214
Practice Address - Country:US
Practice Address - Phone:423-989-5701
Practice Address - Fax:423-989-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS0000010023341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574726Medicaid
TNP00102334OtherRAILROAD MEDICARE
VA1801884275Medicaid
TN3574726Medicaid