Organization
LINCOLN MEDICAL CENTER AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRELL BLAYLOCK (CEO)
(931) 438-7455
Entity
Organization
Contact information
Practice address
106 MEDICAL CENTER BLVD, FAYETTEVILLE, TN 37334-2684
(931) 438-7434
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-0834
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
0000005201
TN
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1534346
—
TN
01
—
P01475369
RAILROAD MEDICARE
TN
Enumeration date
06/05/2014
Last updated
09/23/2021
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