MEDICARE: SCHLEY COUNTY COMMISSIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	12301	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	85033859AA	OTHER	GA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205932381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHLEY COUNTY COMMISSIONER

Provider Business Mailing Address
First Line	:	106 NORTH PECAN STREET
Second Line	:
City	:	ELLAVILLE
State	:	GA
Zip	:	31806
Country	:	US
Telephone Number	:	229-942-3375
Fax Number	:	229-937-5880

Provider Business Practice Location Address
First Line	:	106 NORTH PECAN STREET
Second Line	:
City	:	ELLAVILLE
State	:	GA
Zip	:	31806
Country	:	US
Telephone Number	:	229-942-3375
Fax Number	:	229-937-5880

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MR. DUANE MONTGOMERY
Credential	:
Telephone Number	:	229-942-3375

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2013

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Directions to “SCHLEY COUNTY COMMISSIONER ” Practice Location

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