Pickett County Goverment

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS0000006902 Issued in TN

Legal business name

PICKETT COUNTY GOVERMENT

Practice address

8817 Highway 111
Byrdstown, TN 38549-6003

Phone

(931) 864-3182

Fax

(931) 864-6062

NPI assigned

Nov 4, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Maxie Beaty, EMT-IV

Title

Director

Phone

(931) 864-3182

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1649261983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8817 HIGHWAY 111",
            "city": "BYRDSTOWN",
            "state": "TN",
            "postal_code": "385496003",
            "telephone_number": "931-864-3182",
            "fax_number": "931-864-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8817 HIGHWAY 111",
            "city": "BYRDSTOWN",
            "state": "TN",
            "postal_code": "385496003",
            "telephone_number": "931-864-3182",
            "fax_number": "931-864-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICKETT COUNTY GOVERMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2012-08-23",
        "status": "A",
        "authorized_official_last_name": "BEATY",
        "authorized_official_first_name": "MAXIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "931-864-3182",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EMT-IV"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TN",
            "license": "EMS0000006902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0073894",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181886",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Ames Koger, LPN
• Katherine Rosser Langenberg, MD
• Karen Logan, LPN
• LP Byrdstown LLC
• Larry Michael Mason, M.D.
• Laura B. Reagan, P.T.
• Tim Wayne Reagan, PHARMD
• Victoria Grace Reagan
• Jori Lynne Shaffer, M.D.
• State of Tennessee

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2012; 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.