Healthcare Provider Details

I. General information

NPI: 1821071697
Provider Name (Legal Business Name): JOHNSON COUNTY RESCUE SQUAD EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2005
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 PAUL ANDERSON WAY
MOUNTAIN CITY TN
37683-1837
US

IV. Provider business mailing address

203 PAUL ANDERSON WAY
MOUNTAIN CITY TN
37683-1837
US

V. Phone/Fax

Practice location:
  • Phone: 423-727-6531
  • Fax: 423-727-6932
Mailing address:
  • Phone: 423-727-6531
  • Fax: 423-727-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS4602
License Number StateTN

VIII. Authorized Official

Name: BRAD GENTRY
Title or Position: DIRECTOR
Credential:
Phone: 423-727-6531