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General NPI Number Information
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NPI Number | 1770130155
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Entity Type | Organization
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Legal Business Name | THREE RIVERS EMS LLC
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 204 BEACH RD
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City | BAXLEY
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State | GA
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Zip | 31513-8793
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Country | US
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Telephone | 912-705-3595
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Fax | 912-705-6024
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Provider Business Mailing Address
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Address Line | 204 BEACH RD
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City | BAXLEY
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State | GA
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Zip | 31513-8793
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Country | US
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Telephone | 912-705-3595
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Fax | 912-705-6024
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER PECK
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Credential |
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Telephone | 912-705-3595
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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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