MEDICARE: STEWART COUNTY EMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	EMS00000008101	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4099800	OTHER	TN	BLUECROSSBLUESHIELD-EMER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3149125	OTHER	TN	BLUECROSSBLUESHIELD-NONE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710981238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEWART COUNTY EMS

Provider Business Mailing Address
First Line	:	PO BOX 487
Second Line	:
City	:	DOVER
State	:	TN
Zip	:	37058-0487
Country	:	US
Telephone Number	:	931-232-3093
Fax Number	:	931-232-4859

Provider Business Practice Location Address
First Line	:	719 SPRING ST
Second Line	:
City	:	DOVER
State	:	TN
Zip	:	37058-3208
Country	:	US
Telephone Number	:	931-232-3093
Fax Number	:	931-232-4859

Authorized Official
Title or Position	:	ACCOUNTS BILLING MANAGER
Name	:	ROBYN WATKINS
Credential	:
Telephone Number	:	931-232-1190

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/10/2008

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Directions to “STEWART COUNTY EMS ” Practice Location

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