Healthcare Provider Details

I. General information

NPI: 1972611663
Provider Name (Legal Business Name): BRYAN COUNTY EMERGENCY MEDICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LANIER STREET
PEMBROKE GA
31321
US

IV. Provider business mailing address

116 LANIER STREET
PEMBROKE GA
31321
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-3867
  • Fax: 912-653-3830
Mailing address:
  • Phone: 912-653-3867
  • Fax: 912-653-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number01501
License Number StateGA

VIII. Authorized Official

Name: LINDA S. MILLER
Title or Position: BILLING AND ACCOUNTING CLERK
Credential:
Phone: 912-653-3867