United Medical Response LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

UNITED MEDICAL RESPONSE LLC

Practice address

2425 Jason Industrial Pkwy
Winston, GA 30187

Phone

(770) 672-6434

Fax

(205) 993-4090

NPI assigned

Aug 14, 2009

Last updated

Jul 12, 2018By 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. Charles Derrick Isham

Title

Chief Executive Officer

Phone

(770) 866-2120

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1982836581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E CROSSVILLE RD",
            "address_2": "SUITE 170",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753087",
            "telephone_number": "770-299-1516",
            "fax_number": "770-299-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 JASON INDUSTRIAL PKWY",
            "city": "WINSTON",
            "state": "GA",
            "postal_code": "30187",
            "telephone_number": "770-672-6434",
            "fax_number": "205-993-4090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED MEDICAL RESPONSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-14",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "ISHAM",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DERRICK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "770-866-2120",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Reaves, NP
• Santashia Dinetira Reed, PMHNP
• Tania Masha Sims
• SM&B Group
• Leondria Taty, FNP-C
• Chrissy Wolf
• Reginald Gary Woodell, D.D.S.
• Patricia Wynn

• Land Ambulance in Winston, GA
• Providers in Winston, GA by specialty
• Land Ambulance in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.