Basic Information
| Provider Information | |||||||||
| NPI: | 1861788713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICONE MEDICAL RESPONSE OF TENNESSEE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDICONE MEDICAL RESPONSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707449600 | ||||||||
| FaxNumber: | 2707440834 | ||||||||
| Practice Location | |||||||||
| Address1: | 2904A TAZEWELL PIKE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379181875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707449600 | ||||||||
| FaxNumber: | 2707440834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 02/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | REEVES | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2707449600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDICONE MEDICAL RESPONSE OF TENNESSEE INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 1525655 | 05 | TN | MEDICAID | 710018810 | 05 | KY | MEDICAID | 3409858 | 05 | NC | MEDICAID | 1861788713 | 05 | VA | MEDICAID | 7100188790 | 05 | KY | MEDICAID |