MEDICARE: EMERGENCY MOBILE HEALTH CARE, LLC

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	3416A0800X	Air Ambulance	10175	TN
2	341600000X	Ambulance	315	MS
3	341600000X	Ambulance	EMS0000009975	TN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689679193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY MOBILE HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 382550
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-2550
Country	:	US
Telephone Number	:	901-818-0911
Fax Number	:	901-377-1599

Provider Business Practice Location Address
First Line	:	6972 APPLING FARMS PKWY
Second Line	:	SUITE 110
City	:	MEMPHIS
State	:	TN
Zip	:	38133-4725
Country	:	US
Telephone Number	:	901-818-0911
Fax Number	:	901-377-1599

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	ELBERT O'NEAL ELLIS
Credential	:	PARAMEDIC
Telephone Number	:	901-271-5024

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	01/23/2015

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Directions to “EMERGENCY MOBILE HEALTH CARE, LLC ” Practice Location

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