Provider Demographics
NPI:1982649877
Name:MEDSTAT EMERGENCY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:MEDSTAT EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-PARAMEDIC
Authorized Official - Phone:404-763-2273
Mailing Address - Street 1:PO BOX 962170
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6918
Mailing Address - Country:US
Mailing Address - Phone:404-763-2273
Mailing Address - Fax:404-305-9626
Practice Address - Street 1:2975 METROPOLITAN PKWY SW
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7917
Practice Address - Country:US
Practice Address - Phone:404-763-2273
Practice Address - Fax:404-305-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000372039AMedicaid
GA85057759AAOtherPTAN
GA85057759AAOtherPTAN