Organization
COUNTY OF HICKMAN OFFICE OF COUNTY EXECUTIVE
Active
Parent organization
COUNTY OF HICKMAN OFFICE OF COUNTY EXEC
Other names
Hickman County Ambulance Service
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF HICKMAN OFFICE OF COUNTY EXEC
Authorized official
DESTINY VAN METRE (PROVIDER ENROLLMENT)
(270) 744-8413
Entity
Organization
Contact information
Practice address
106 E. SWAN ST, CENTERVILLE, TN 37033
(931) 729-3004
(931) 729-5528
Mailing address
106 E. SWAN ST, CENTERVILLE, TN 37033
(931) 729-3004
(931) 729-5528
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3525528
—
TN
01
—
4110080
BCBS
TN
01
—
709849100
DOL - FECA / BL / ENERGY
TN
Enumeration date
11/10/2005
Last updated
02/03/2023
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