# BULLOCH COUNTY EMERGENCY MEDICAL SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013025642
- **Authorized official:** MR. DOUGLAS C VICKERS (INTERIM DIRECTOR)
- **Authorized official phone:** (912) 764-6188

## Contact information

- **Practice address:** 26 W GRADY ST, STATESBORO, GA 30458-2742
- **Practice address phone:** (912) 764-6188
- **Practice address fax:** (912) 489-8917
- **Mailing address:** PO BOX 1409, STATESBORO, GA 30459-1409
- **Mailing address phone:** (912) 764-6188
- **Mailing address fax:** (912) 489-8917

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 01602 | GA | Yes |

## Other

- **Enumeration date:** 08/25/2006
- **Last updated:** 01/09/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00263227A | — | GA |