Healthcare Provider Details

I. General information

NPI: 1649261983
Provider Name (Legal Business Name): PICKETT COUNTY GOVERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8817 HIGHWAY 111
BYRDSTOWN TN
38549-6003
US

IV. Provider business mailing address

8817 HIGHWAY 111
BYRDSTOWN TN
38549-6003
US

V. Phone/Fax

Practice location:
  • Phone: 931-864-3182
  • Fax: 931-864-6062
Mailing address:
  • Phone: 931-864-3182
  • Fax: 931-864-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS0000006902
License Number StateTN

VIII. Authorized Official

Name: MR. MAXIE BEATY
Title or Position: DIRECTOR
Credential: EMT-IV
Phone: 931-864-3182