Provider Demographics
NPI:1952411886
Name:LINCOLN COUNTY BOARD OF COMMISSIONERS
Entity type:Organization
Organization Name:LINCOLN COUNTY BOARD OF COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, LINCOLN CO. EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-359-4855
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-0340
Mailing Address - Country:US
Mailing Address - Phone:706-359-4855
Mailing Address - Fax:706-359-5507
Practice Address - Street 1:1056 GLOBAL DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:GA
Practice Address - Zip Code:30817-5433
Practice Address - Country:US
Practice Address - Phone:706-359-4855
Practice Address - Fax:706-359-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA090-01341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000326169AMedicaid
GA000326169AMedicaid