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General NPI Number Information
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NPI Number | 1689623050
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Entity Type | Organization
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Legal Business Name | COUNTY OF HARDEMAN
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 225 LUCY BLACK ROAD
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City | BOLIVAR
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State | TN
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Zip | 38008
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Country | US
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Telephone | 731-659-3772
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 49
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City | BOLIVAR
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State | TN
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Zip | 38008-0049
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Country | US
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Telephone | 731-659-3772
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Fax | 731-658-1898
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMIE A BURNETT
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Credential |
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Telephone | 731-659-3772
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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 | EMS0000003502
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License Number State | TN
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