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General NPI Number Information
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NPI Number | 1649261983
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Entity Type | Organization
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Legal Business Name | PICKETT COUNTY GOVERMENT
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 8817 HIGHWAY 111
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City | BYRDSTOWN
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State | TN
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Zip | 38549-6003
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Country | US
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Telephone | 931-864-3182
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Fax | 931-864-6062
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Provider Business Mailing Address
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Address Line | 8817 HIGHWAY 111
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City | BYRDSTOWN
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State | TN
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Zip | 38549-6003
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Country | US
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Telephone | 931-864-3182
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Fax | 931-864-6062
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MAXIE BEATY
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Credential | EMT-IV
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Telephone | 931-864-3182
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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 | EMS0000006902
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License Number State | TN
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