Provider Demographics
NPI:1831231216
Name:IRWIN COUNTY EMS
Entity type:Organization
Organization Name:IRWIN COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-468-9594
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-0501
Mailing Address - Country:US
Mailing Address - Phone:229-468-9594
Mailing Address - Fax:229-468-9673
Practice Address - Street 1:108 COTTON DRIVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-0501
Practice Address - Country:US
Practice Address - Phone:229-468-9594
Practice Address - Fax:229-468-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA077-013416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA590014503OtherRAILROAD MEDICARE
GA000153205AMedicaid
GA198047OtherBCBS OF GA
GA590014503OtherRAILROAD MEDICARE