Basic Information
| Provider Information | |||||||||
| NPI: | 1962478511 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRISP COUNTY EMERGENCY MEDICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5007 | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310105007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292719686 | ||||||||
| FaxNumber: | 2292719689 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 A HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292719686 | ||||||||
| FaxNumber: | 2292719689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 12/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILDER | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | WADE | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERNAL AUDITOR | ||||||||
| AuthorizedOfficialTelephone: | 2292719686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 4001 | GA | Y | Transportation Services | Ambulance |
No ID Information.