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General NPI Number Information
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NPI Number | 1467916387
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Entity Type | Organization
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Legal Business Name | MEDSTAR EMS LLC
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 8321 OFFICE PARK DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6936
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Country | US
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Telephone | 404-319-6038
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 PRITCHETT INDUSTRIAL BLVD
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City | AUSTELL
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State | GA
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Zip | 30168-5520
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Country | US
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Telephone | 404-319-6038
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | GLEN F VANN
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Credential |
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Telephone | 404-319-6038
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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 |
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License Number State |
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