Blue Cross EMS LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

AMB2016005 Issued in GA

Legal business name

BLUE CROSS EMS LLC

Practice address

3 Pine Grove Dr
Locust Grove, GA 30248-2561

Phone

(404) 520-9009

Fax

(678) 782-3222

NPI assigned

Mar 22, 2016

Last updated

Mar 22, 2016By 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

Mr. Kyle Mitchell Brewer

Title

Ceo

Phone

(404) 520-9009

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1427410208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PINE GROVE DR",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482561",
            "telephone_number": "404-520-9009",
            "fax_number": "678-782-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 PINE GROVE DR",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482561",
            "telephone_number": "404-520-9009",
            "fax_number": "678-782-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE CROSS EMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "MITCHELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-520-9009",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": "AMB2016005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Locust Grove, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.