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General NPI Number Information
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NPI Number | 1871554824
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Entity Type | Organization
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Legal Business Name | COCKE COUNTY AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 245 BYBEE RD
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City | NEWPORT
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State | TN
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Zip | 37821-4603
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Country | US
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Telephone | 423-608-3109
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Fax | 623-625-4043
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Provider Business Mailing Address
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Address Line | 245 BYBEE RD
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City | NEWPORT
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State | TN
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Zip | 37821-4603
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Country | US
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Telephone | 423-608-3109
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Fax | 623-625-4043
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Authorized Official
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Title or Position | OWNER
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Name | JERRY A HOLT
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Credential | PARAMEDIC
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Telephone | 423-608-3109
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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 | EMS0000010024
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License Number State | TN
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