Puckett Emergency Medical Services, LLC

Primary specialty

AmbulanceTaxonomy code 341600000X

License

03343 Issued in GA

Legal business name

PUCKETT EMERGENCY MEDICAL SERVICES, LLC

Doing business as

Puckett Emergency Medical Services
Puckett EMS

Practice address

3760 Tramore Point Pkwy
Austell, GA 30106

Phone

(770) 222-5045

Fax

(770) 943-5150

NPI assigned

Sep 9, 2005

Last updated

Aug 9, 2023By 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. Robert A Jewell

Title

Chief Revenue Integration Officer

Phone

(844) 597-4911

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 3

• PUCKETT EMERGENCY MEDICAL SERVICES Doing business as
• PUCKETT EMS Doing business as
• PUCKETT EMERGENCY MEDICAL SERVICES, INC Former legal business name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Puckett Emergency Medical Services, LLC

  dba Puckett Emergency Medical Services

  • Land Ambulance
  • East Ridge, TN
  • NPI 1720300379

  3870549975

  Same PAC ID

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

CLIA laboratory certificates

Tax ID family

Puckett Emergency Medical Services2 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.

• Puckett Emergency Medical Services, LLC

  dba Puckett Emergency Medical Services

  • Land Ambulance
  • East Ridge, TN
  • NPI 1720300379
  NPD tax ID

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691539200000",
    "number": "1699769158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650523",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650523",
            "telephone_number": "844-597-4911",
            "fax_number": "866-687-2796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 TRAMORE POINT PKWY",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "30106",
            "telephone_number": "770-222-5045",
            "fax_number": "770-943-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUCKETT EMERGENCY MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A",
        "authorized_official_last_name": "JEWELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF REVENUE INTEGRATION OFFICER",
        "authorized_official_telephone_number": "844-597-4911",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "GA",
            "license": "03343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000902107A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PUCKETT EMERGENCY MEDICAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PUCKETT EMERGENCY MEDICAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PUCKETT EMS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PUCKETT EMERGENCY MEDICAL SERVICES, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.