Provider Demographics
NPI:1902917586
Name:AMBULANCE SERVICES OF DYERSBURG, INC.
Entity Type:Organization
Organization Name:AMBULANCE SERVICES OF DYERSBURG, INC.
Other - Org Name:DYERSBURG REGIONAL EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7000
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-0217
Mailing Address - Country:US
Mailing Address - Phone:615-465-7587
Mailing Address - Fax:615-250-0559
Practice Address - Street 1:400 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3120
Practice Address - Country:US
Practice Address - Phone:731-660-6369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000100123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3574771Medicaid
TN3574771Medicare ID - Type UnspecifiedMEDICARE PART-B