Healthcare Provider Details

I. General information

NPI: 1689623050
Provider Name (Legal Business Name): COUNTY OF HARDEMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/03/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 LUCY BLACK ROAD
BOLIVAR TN
38008
US

IV. Provider business mailing address

PO BOX 49
BOLIVAR TN
38008-0049
US

V. Phone/Fax

Practice location:
  • Phone: 731-659-3772
  • Fax:
Mailing address:
  • Phone: 731-659-3772
  • Fax: 731-658-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS0000003502
License Number StateTN

VIII. Authorized Official

Name: JAMIE A BURNETT
Title or Position: DIRECTOR
Credential:
Phone: 731-659-3772