Organization
SOUTHEAST AMBULANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY E HENDERLIGHT JR. (MANAGING MEMBER)
(423) 624-9990
Entity
Organization
Contact information
Practice address
2511 RIVERSIDE DR, SUITE C-3, CHATTANOOGA, TN 37406-3700
(423) 624-9990
Mailing address
PO BOX 5583, CHATTANOOGA, TN 37406-0583
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
EMS0000010029
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3474827
—
TN
Enumeration date
12/07/2006
Last updated
08/22/2020
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