Van Buren County Courthouse SQ
Organization Active NPI Land Ambulance · Spencer, TN
NPI 1740261981 · NPPES record last updated Jan 18, 2012
Key facts
- NPI
- 1740261981
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- EMS0000009996 (TN)
- Legal business name
- VAN BUREN COUNTY COURTHOUSE SQ
- Practice address
- 112 Generations Dr
Spencer, TN 38585-3027 - Phone
- (931) 946-8181
- Fax
- (931) 946-8182
- NPI assigned
- Nov 6, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Tiwanna Bricker, EMT-P
- Title
- Director
- Phone
- (931) 946-8181
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041123000629 | TN | Part B Supplier - Ambulance Service Supplier | 5092770610 | Practice locations: Spencer, TN |
National Provider Directory
Locations
112 Generations Dr
Spencer, TN 38585
Phone (931) 946-8181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | EMS0000009996 | TN | Yes |
Addresses
Primary practice location
112 Generations Dr
Spencer, TN 38585-3027
Mailing address
112 Generations Dr
Spencer, TN 38585-3027
Phone (931) 946-8181
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4121233 | Other | TN | BCBS EMERGENCY |
| 3129083 | Other | TN | BCBS NON-EMERGENCY |
Other names
- Van Buren County EMS
Other providers in Spencer, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.