Healthcare Provider Details

I. General information

NPI: 1154302982
Provider Name (Legal Business Name): HAYWOOD COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WELCH ST
BROWNSVILLE TN
38012-2334
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 731-772-4979
  • Fax: 731-772-9943
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS0000003801
License Number StateTN

VIII. Authorized Official

Name: DAVID SMITH
Title or Position: DIRECTOR
Credential:
Phone: 731-772-4979