Provider Demographics
NPI:1639472855
Name:S P ACQUISITION CENTER
Entity type:Organization
Organization Name:S P ACQUISITION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDONKELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-764-3048
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:1000 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3638
Practice Address - Country:US
Practice Address - Phone:423-837-9500
Practice Address - Fax:423-837-3230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S P ACQUISITION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-09
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1234567341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G593873Medicare PIN