Healthcare Provider Details

I. General information

NPI: 1457322612
Provider Name (Legal Business Name): GRUNDY EMERGENCY MEDICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PHIPPS STREET
COALMONT TN
37313
US

IV. Provider business mailing address

90 PHIPPS ST PO BOX 327
COALMONT TN
37313
US

V. Phone/Fax

Practice location:
  • Phone: 931-592-2252
  • Fax: 931-592-2260
Mailing address:
  • Phone: 931-592-2252
  • Fax: 931-592-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS0000009955
License Number StateTN

VIII. Authorized Official

Name: MR. DON HUTCHESON
Title or Position: DIRECTOR
Credential: PARAMEDIC
Phone: 931-592-2252