Okefenokee EMS Inc.

Primary specialty

AmbulanceTaxonomy code 341600000X

License

148-05 Issued in GA

Legal business name

OKEFENOKEE EMS INC.

Practice address

611 Riverside Ave
Waycross, GA 31501-5322

Phone

(912) 284-9111

NPI assigned

Nov 7, 2006

Last updated

Aug 22, 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

Mr. Derek Daniel Mallard, EMT-P

Title

Ceo

Phone

(912) 284-9111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598834459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1433",
            "address_2": "611 RIVERSIDE AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315021433",
            "telephone_number": "912-284-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 RIVERSIDE AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015322",
            "telephone_number": "912-284-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKEFENOKEE EMS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALLARD",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-284-9111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EMT-P"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "GA",
            "license": "148-05",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randall Frederick O'Brien, M.D.
• Aleta Deonne O'Quinn
• Greta D O'Steen, RN
• OB-GYN Associates of Waycross, PLLC
• Okefenokee Anesthesia Company LLC
• Okefenokee Pharmacy of Waycross, LLC (Batten's Prescription Shoppe Long-Term Care)
• Okefenokee Pharmacy of Waycross, LLC Dba Batten's Prescription Shoppe (Batten's Prescription Shoppe)
• Okefenokee Prescription Shoppe, Inc.
• Janie B Oliver, PHD
• Oncology Hematology Care Center, Inc

• Ambulance in Waycross, GA
• Providers in Waycross, GA by specialty
• Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.