Provider Demographics
NPI:1831230093
Name:EMPACT MEDICAL SERVICES
Entity type:Organization
Organization Name:EMPACT MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR CO-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEBUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-223-1777
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-1347
Mailing Address - Country:US
Mailing Address - Phone:615-223-1777
Mailing Address - Fax:615-223-6050
Practice Address - Street 1:700 SWAN DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2035
Practice Address - Country:US
Practice Address - Phone:615-223-1777
Practice Address - Fax:615-223-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574412Medicaid
TN3574412Medicare ID - Type Unspecified