NPIMap

Organization Active NPI

Emergency Medical Service of Randolph County Ga

  • Land Ambulance
  • Cuthbert, GA
National Provider Identifier
1124079389
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
12001 Issued in GA
Legal business name
EMERGENCY MEDICAL SERVICE OF RANDOLPH COUNTY GA
Practice address
34 Taylor Street
Cuthbert, GA 39840-1338
Phone
(229) 732-6632
Fax
(229) 732-2139
NPI assigned
May 13, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Ellette Jackson, PARAMEDIC
Title
EMS Director
Phone
(229) 732-6632

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Locations

34 Taylor St
Cuthbert, GA 39840
Phone (229) 732-6632

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 12001 GA Primary

Addresses

NPPES NPI Registry

Primary practice location

34 Taylor Street
Cuthbert, GA 39840-1338

Mailing address

361 Randolph Street
Cuthbert, GA 39840-1338
Phone (229) 732-6632

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
000002593AMedicaidGA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 29, 2010.

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290988800000",
    "number": "1124079389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 RANDOLPH STREET",
            "city": "CUTHBERT",
            "state": "GA",
            "postal_code": "398401338",
            "telephone_number": "229-732-6632",
            "fax_number": "229-732-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 TAYLOR STREET",
            "city": "CUTHBERT",
            "state": "GA",
            "postal_code": "398401338",
            "telephone_number": "229-732-6632",
            "fax_number": "229-732-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY MEDICAL SERVICE OF RANDOLPH COUNTY GA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-13",
        "last_updated": "2010-11-29",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ELLETTE",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "229-732-6632",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "12001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000002593A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cuthbert, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.