Organization
COUNTY OF LAKE
Active
Other names
Lake County Emergency Medical Service
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MACIE M ROBERSON (COUNTY MAYOR)
(731) 253-7382
Entity
Organization
Contact information
Practice address
333 KENTUCKY ST, TIPTONVILLE, TN 38079-1212
(731) 253-9911
(731) 253-3229
Mailing address
333 KENTUCKY ST, TIPTONVILLE, TN 38079-1212
(731) 253-9911
(731) 253-3229
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
EMS0000004801
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21851
—
TN
05
—
3525546
—
TN
Enumeration date
10/26/2005
Last updated
02/14/2013
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