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General NPI Number Information
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NPI Number | 1710950704
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Entity Type | Organization
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Legal Business Name | CANNON COUNTY AMBULANCE SERVICE
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 104 ALEXANDER DR
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City | WOODBURY
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State | TN
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Zip | 37190-5275
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Country | US
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Telephone | 615-563-5959
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Fax | 615-563-6878
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Provider Business Mailing Address
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Address Line | PO BOX 9150
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City | PADUCAH
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State | KY
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Zip | 42002-9150
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Country | US
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Telephone | 270-744-9600
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Fax | 270-744-8642
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUSTIN HARRIS
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Credential |
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Telephone | 615-653-2655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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Taxonomy #2
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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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