MEDICARE: BRYAN COUNTY EMERGENCY MEDICAL 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	3416L0300X	Land Ambulance	01501	GA

General Provider Information

NPI Number	:	1972611663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN COUNTY EMERGENCY MEDICAL SERVICE

Provider Business Mailing Address
First Line	:	116 LANIER STREET
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321
Country	:	US
Telephone Number	:	912-653-3867
Fax Number	:	912-653-3830

Provider Business Practice Location Address
First Line	:	116 LANIER STREET
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321
Country	:	US
Telephone Number	:	912-653-3867
Fax Number	:	912-653-3830

Authorized Official
Title or Position	:	BILLING AND ACCOUNTING CLERK
Name	:	LINDA S. MILLER
Credential	:
Telephone Number	:	912-653-3867

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/22/2020

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