Van Buren County Courthouse SQ

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS0000009996 Issued in TN

Legal business name

VAN BUREN COUNTY COURTHOUSE SQ

Doing business as

Van Buren County EMS

Practice address

112 Generations Dr
Spencer, TN 38585-3027

Phone

(931) 946-8181

Fax

(931) 946-8182

NPI assigned

Nov 6, 2005

Last updated

Jan 18, 2012By 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

Mrs. Tiwanna Bricker, EMT-P

Title

Director

Phone

(931) 946-8181

Specialties & licenses 1

Addresses

Other names 1

• Van Buren County EMS Doing business as

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": "1131235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326844800000",
    "number": "1740261981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 GENERATIONS DR",
            "city": "SPENCER",
            "state": "TN",
            "postal_code": "385853027",
            "telephone_number": "931-946-8181",
            "fax_number": "931-946-8182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 GENERATIONS DR",
            "city": "SPENCER",
            "state": "TN",
            "postal_code": "385853027",
            "telephone_number": "931-946-8181",
            "fax_number": "931-946-8182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN BUREN COUNTY COURTHOUSE SQ",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-06",
        "last_updated": "2012-01-18",
        "status": "A",
        "authorized_official_last_name": "BRICKER",
        "authorized_official_first_name": "TIWANNA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "931-946-8181",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "EMT-P"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TN",
            "license": "EMS0000009996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Van Buren County EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patrick Powers
• Premier Care Transport
• Robert David Sapp, MD
• Spencer Drug Co,, LLC
• State of Tennessee (Van Buren County Health Department)
• Peggy Deloris Welch, RN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.