Peach State EMS, LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

078-04 Issued in GA

Legal business name

PEACH STATE EMS, LLC

Practice address

122 Amy Industrial LN
Hoschton, GA 30548-2469

Phone

(888) 838-1391

Fax

(888) 391-8501

NPI assigned

Jun 2, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Devin Ray Stancliff, PARAMEDIC

Title

Owner

Phone

(678) 828-1250

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1184037616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 545",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305170010",
            "telephone_number": "888-838-1391",
            "fax_number": "888-391-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 AMY INDUSTRIAL LN",
            "city": "HOSCHTON",
            "state": "GA",
            "postal_code": "305482469",
            "telephone_number": "888-838-1391",
            "fax_number": "888-391-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE EMS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "STANCLIFF",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-828-1250",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "078-04",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA STATE EMS LICENSE NUMBER",
            "identifier": "078-04",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Hoschton, GA
• Providers in Hoschton, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.