Provider Demographics
NPI:1811328230
Name:MUSCOGEE AMBULANCE LLC
Entity type:Organization
Organization Name:MUSCOGEE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZAYEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-822-7373
Mailing Address - Street 1:3554 HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7302
Mailing Address - Country:US
Mailing Address - Phone:762-822-8841
Mailing Address - Fax:706-507-0899
Practice Address - Street 1:3554 HILTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7302
Practice Address - Country:US
Practice Address - Phone:762-822-8841
Practice Address - Fax:706-507-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106-133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport