Provider Demographics
NPI: | 1265720031 |
---|---|
Name: | AMBULANCE SERVICE OF MURFREESBORO, LLC |
Entity type: | Organization |
Organization Name: | AMBULANCE SERVICE OF MURFREESBORO, LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CRAIG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-293-2533 |
Mailing Address - Street 1: | 142 HERITAGE PARK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MURFREESBORO |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37129-1548 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-293-2533 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 142 HERITAGE PARK DR |
Practice Address - Street 2: | |
Practice Address - City: | MURFREESBORO |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37129-1548 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-293-2533 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-07-14 |
Last Update Date: | 2011-07-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | EMS0000010140 | 3416L0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3416L0300X | Transportation Services | Ambulance | Land Transport |