Organization
PICKETT COUNTY GOVERMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAXIE BEATY EMT-IV (DIRECTOR)
(931) 864-3182
Entity
Organization
Contact information
Practice address
8817 HIGHWAY 111, BYRDSTOWN, TN 38549-6003
(931) 864-3182
(931) 864-6062
Mailing address
8817 HIGHWAY 111, BYRDSTOWN, TN 38549-6003
(931) 864-3182
(931) 864-6062
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
EMS0000006902
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0073894
BCBS
TN
05
—
181886
—
TN
Enumeration date
11/04/2005
Last updated
08/23/2012
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