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General NPI Number Information
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NPI Number | 1821071697
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Entity Type | Organization
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Legal Business Name | JOHNSON COUNTY RESCUE SQUAD EMS
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Dates
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Enumeration Date | 11/24/2005
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 203 PAUL ANDERSON WAY
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City | MOUNTAIN CITY
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State | TN
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Zip | 37683-1837
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Country | US
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Telephone | 423-727-6531
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Fax | 423-727-6932
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Provider Business Mailing Address
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Address Line | 203 PAUL ANDERSON WAY
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City | MOUNTAIN CITY
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State | TN
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Zip | 37683-1837
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Country | US
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Telephone | 423-727-6531
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Fax | 423-727-6932
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRAD GENTRY
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Credential |
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Telephone | 423-727-6531
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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 | EMS4602
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License Number State | TN
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