Organization
SOUTHERN EMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYLER MICHAEL BLANKENSHIP (MANAGER)
(304) 664-3848
Entity
Organization
Contact information
Practice address
HC 68 BOX 456, HANOVER, WV 24839-9731
(304) 664-3848
(304) 664-3669
Mailing address
PO BOX 456, JUSTICE, WV 24851-0456
(304) 664-3848
(304) 664-3669
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
2295-6669
WV
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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