MEDICARE: MURFREESBORO CONVALESCENT SERVICE

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	EMS0000007503	TN

General Provider Information

NPI Number	:	1326041534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURFREESBORO CONVALESCENT SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 759
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37133-0759
Country	:	US
Telephone Number	:	615-890-3463
Fax Number	:	615-895-8867

Provider Business Practice Location Address
First Line	:	4428 LASCASSAS PIKE
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-6871
Country	:	US
Telephone Number	:	615-890-3463
Fax Number	:	615-895-8867

Authorized Official
Title or Position	:	EMTA OWNER
Name	:	MR. WOODY HARRELL MEDLOCK SR.
Credential	:
Telephone Number	:	615-890-3463

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/26/2008

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