Provider Demographics
NPI:1821071697
Name:JOHNSON COUNTY RESCUE SQUAD EMS
Entity type:Organization
Organization Name:JOHNSON COUNTY RESCUE SQUAD EMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-727-6531
Mailing Address - Street 1:203 PAUL ANDERSON WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-1837
Mailing Address - Country:US
Mailing Address - Phone:423-727-6531
Mailing Address - Fax:423-727-6932
Practice Address - Street 1:203 PAUL ANDERSON WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1837
Practice Address - Country:US
Practice Address - Phone:423-727-6531
Practice Address - Fax:423-727-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-24
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS46023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3560765Medicaid
TN3560765Medicaid