Healthcare Provider Details

I. General information

NPI: 1093636284
Provider Name (Legal Business Name): EMS TEAM OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 HANGAR DR
VANDALIA OH
45377-1056
US

IV. Provider business mailing address

PO BOX 189
VANDALIA OH
45377-0189
US

V. Phone/Fax

Practice location:
  • Phone: 937-877-1235
  • Fax:
Mailing address:
  • Phone: 937-949-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DERECK PRISTAS
Title or Position: PRESIDENT
Credential:
Phone: 937-949-4611