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General NPI Number Information
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NPI Number | 1063843597
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Entity Type | Organization
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Legal Business Name | TRINITY EMS LLC
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 155 WESTRIDGE PKWY SUITE 210
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City | MCDONOUGH
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State | GA
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Zip | 30253-3051
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Country | US
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Telephone | 770-914-8803
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Fax | 770-914-8949
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Provider Business Mailing Address
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Address Line | 155 WESTRIDGE PKWY SUITE 210
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City | MCDONOUGH
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State | GA
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Zip | 30253-3051
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Country | US
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Telephone | 770-914-8803
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Fax | 770-914-8949
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JASON ALAN CORMIER
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Credential | EMT-I
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Telephone | 770-709-1462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 075-13
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License Number State | GA
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