NPIMap

Organization Active NPI

Sullivan County EMS

  • Ambulance
  • Blountville, TN
National Provider Identifier
1154320687
Registry record updated Jun 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
Legal business name
SULLIVAN COUNTY EMS
Practice address
3193 Highway 126
Blountville, TN 37617
Phone
(423) 323-6471
Fax
(423) 279-2813
NPI assigned
Jul 18, 2005
Last updated
Jun 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jim Perry
Title
Chief
Phone
(423) 323-6474

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X EMS0000008201 TN
Ambulance 341600000X TN Primary

Addresses

Primary practice location

3193 Highway 126
Blountville, TN 37617

Mailing address

PO Box 398
Blountville, TN 37617
Phone (423) 323-6474

Other identifiers 3

IdentifierTypeStateIssuer
3520413MedicaidTN
002007565MedicaidTN
100021464MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111031000405 TN Part B Supplier - Ambulance Service Supplier 9234302613 Practice locations: Blountville, TN; Kingsport, TN; Bluff City, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Sullivan County Regional Health Department7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3193 Highway 126
Blountville, TN 37617
Phone (423) 323-6471

3411 Highway 126
Ste 204
Blountville, TN 37617

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1154320687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "37617",
            "telephone_number": "423-323-6474",
            "fax_number": "423-279-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3193 HIGHWAY 126",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "37617",
            "telephone_number": "423-323-6471",
            "fax_number": "423-279-2813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN COUNTY EMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "423-323-6474"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "TN",
            "license": "EMS0000008201",
            "primary": false
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3520413",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002007565",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100021464",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blountville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.