Monroe County Ambulance Service

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS0000006201 Issued in TN

Legal business name

MONROE COUNTY AMBULANCE SERVICE

Doing business as

Monroe County Ambulance Service

Practice address

210 Lewis St.
Madisonville, TN 37354-1515

Phone

(423) 442-4063

Fax

(423) 442-8089

NPI assigned

Aug 18, 2006

Last updated

Mar 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randy White

Title

Director

Phone

(423) 442-4063

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Monroe County Ambulance Service Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Tax ID family

Monroe County Dental Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Monroe County Dental Clinic

  • Dentist
  • Madisonville, TN
  • NPI 1023268828
  NPD tax ID

Locations

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585526400000",
    "number": "1417061136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 TELLICO ST.",
            "address_2": "SUITE 1",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "37354",
            "telephone_number": "423-442-4063",
            "fax_number": "423-442-8089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 LEWIS ST.",
            "city": "MADISONVILLE",
            "state": "TN",
            "postal_code": "373541515",
            "telephone_number": "423-442-4063",
            "fax_number": "423-442-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE COUNTY AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "423-442-4063"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TN",
            "license": "EMS0000006201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDBLACKLUNGPROGRAM",
            "identifier": "800157",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTN",
            "identifier": "0009850",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "590080330",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180486",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroe County Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monroe County Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James K McCollum
• Kendra Jane McDonald, PTA
• Cassandra McKay
• Derek Meacham, MPT
• Keshia Millsaps
• Monroe County Dental Clinic
• Monroe County Health Dept
• Monroe County Health Dept.
• Monroe Health and Rehabilitation Center LLC (Monroe Health and Rehabilitation Center)
• Jennifer Tull Morgan, MS, OTR/L, MBA, CLT

• Land Ambulance in Madisonville, TN
• Providers in Madisonville, TN by specialty
• Land Ambulance in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; 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.