Basic Information
| Provider Information | |||||||||
| NPI: | 1477701472 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHLAND EMERGENCY MEDICAL SERVICES, L.L.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1276 | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317991276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292360831 | ||||||||
| FaxNumber: | 2292360871 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E MADISON ST | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292360831 | ||||||||
| FaxNumber: | 2292360871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | FLETCHER | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2292360831 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | 050087 | GA | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Contractor | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.