County of Lake

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS0000004801 Issued in TN

Legal business name

COUNTY OF LAKE

Doing business as

Lake County Emergency Medical Service

Practice address

333 Kentucky St
Tiptonville, TN 38079-1212

Phone

(731) 253-9911

Fax

(731) 253-3229

NPI assigned

Oct 26, 2005

Last updated

Feb 14, 2013By 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. Macie M Roberson

Title

County Mayor

Phone

(731) 253-7382

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lake County Emergency Medical Service Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360800000000",
    "number": "1730179250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 KENTUCKY ST",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380791212",
            "telephone_number": "731-253-9911",
            "fax_number": "731-253-3229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 KENTUCKY ST",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380791212",
            "telephone_number": "731-253-9911",
            "fax_number": "731-253-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2013-02-14",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "MACIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "COUNTY MAYOR",
        "authorized_official_telephone_number": "731-253-7382",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TN",
            "license": "EMS0000004801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3525546",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21851",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake County Emergency Medical Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blue Ribbon Dental Center LLC
• Daniel W. Bruce, M.D.
• Cinderella Wigs & Breast Prosthetics
• Citizens of Lake County for Health Care Inc (Lake County Primary Care)
• Amanda Collins, PA-C
• Kristen Deaton, PMHNP-BC
• Kerri A Ervin, FNP
• Courtney Faught, APN
• Colton Edward Gramse, DNP, APRN, PMHNP-BC
• Carol Winfred Guess, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; 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.