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General NPI Number Information
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NPI Number | 1770253684
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Entity Type | Organization
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Legal Business Name | PURPLE HEARTS EMS, LLC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 1700 PENNSYLVANIA AVE STE 109
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City | MCDONOUGH
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State | GA
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Zip | 30253-9115
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Country | US
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Telephone | 678-978-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 PENNSYLVANIA AVE STE 109
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City | MCDONOUGH
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State | GA
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Zip | 30253-9115
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Country | US
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Telephone | 678-978-4855
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE STAFF
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Name | TIFFANY ALLEN
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Credential |
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Telephone | 678-978-4855
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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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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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