# SOUTHERN EMS LLC

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

## Provider details

- **NPI number:** 1417352840
- **Authorized official:** MR. TYLER MICHAEL BLANKENSHIP (MANAGER)
- **Authorized official phone:** (304) 664-3848

## Contact information

- **Practice address:** HC 68 BOX 456, HANOVER, WV 24839-9731
- **Practice address phone:** (304) 664-3848
- **Practice address fax:** (304) 664-3669
- **Mailing address:** PO BOX 456, JUSTICE, WV 24851-0456
- **Mailing address phone:** (304) 664-3848
- **Mailing address fax:** (304) 664-3669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 2295-6669 | WV | Yes |

## Other

- **Enumeration date:** 10/28/2014
- **Last updated:** 10/28/2014