Provider Demographics
NPI:1518948959
Name:COUNTY OF WHITE
Entity type:Organization
Organization Name:COUNTY OF WHITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-836-3216
Mailing Address - Street 1:1 E BOCKMAN WAY
Mailing Address - Street 2:RM 204
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-2049
Mailing Address - Country:US
Mailing Address - Phone:931-836-3216
Mailing Address - Fax:931-836-3343
Practice Address - Street 1:1 E BOCKMAN WAY
Practice Address - Street 2:WHITE CO. COURTHOUSE RM # 204
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2049
Practice Address - Country:US
Practice Address - Phone:931-836-3216
Practice Address - Fax:931-836-3343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE COUNTY EMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-11
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000093023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN108250OtherCOMMERICAL
TN3559361Medicare ID - Type Unspecified