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General NPI Number Information
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NPI Number | 1225100589
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Entity Type | Organization
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Legal Business Name | MARION COUNTY COMMISSIONER OF ROADS AND REVENUE
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 100 BURKHALTER AVE
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City | BUENA VISTA
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State | GA
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Zip | 31803-9701
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Country | US
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Telephone | 229-314-4569
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Fax | 229-649-2033
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Provider Business Mailing Address
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Address Line | PO BOX 702
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City | BUENA VISTA
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State | GA
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Zip | 31803-0702
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Country | US
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Telephone | 229-649-3025
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Fax | 229-649-2033
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Authorized Official
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Title or Position | EMS DIRECTOR
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Name | MARK C DEJONG
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Credential |
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Telephone | 229-314-4569
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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 | 096-01
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License Number State | GA
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