DEEP SOUTH AMBULANCE SERVICE, INC (NPI# 1073662805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073662805 |
| Entity Type | Organization |
| Organization Name | DEEP SOUTH AMBULANCE SERVICE, INC |
| Practice Address |
37 Peachtree Street Lakeland GA 31635-0067 |
| Mailing Address |
Po Box 67 37 Peachtree St Lakeland GA 31635-0067 |
| Practice Telephone | 2294822899 |
| Mailing Telephone | 2294822899 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2013-01-15 |
| Authorized Official Name | MR. JOHN WESLEY PRUITT SR. (OWNER) |
| Authorized Official Telephone | 2294822899 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3416L0300X |
Ambulance Specialization: Land Transport |
086-02 | GA | Transportation Services |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00432528A | 05 |
| Street Address |
37 PEACHTREE STREET |
| City | LAKELAND |
| State | GA |
| Zip Code | 31635-0067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730252479 | South Georgia Csb | Clinic/Center | 321 W Brantley, Lakeland, GA 31635 | 2006-11-17 |
| 1427128545 | Lanier County Board Sbs | Local Education Agency (LEA) | Hwy 221 South, Lakeland, GA 31635 | 2006-11-08 |
| 1558318337 | Lanier Health Services, Inc | Nursing Facility/Intermediate Care Facility | 852 W Thigpen Ave, Lakeland, GA 31635-1006 | 2006-05-27 |
| 1093921629 | Lanier County Ambulance Service | Ambulance | 116 W Thigpen Ave, Lakeland, GA 31635-1006 | 2007-05-14 |
| 1649284001 | James A Harrell | Emergency Medicine | 852 W Thigpen Ave, Lakeland, GA 31635-1006 | 2006-07-28 |
| 1023060084 | Lanier Health Services, Inc. | Medicare Defined Swing Bed Unit | 116 W Thigpen Ave, Lakeland, GA 31635-1006 | 2006-05-17 |
| 1558775411 | Kristen Ley | Nurse Practitioner | 106 W Thigpen Ave, Lakeland, GA 31635-1011 | 2014-06-18 |
| 1194141549 | Hospital Authority of Valdosta and Lowndes County, Georgia | Nursing Facility/Intermediate Care Facility | 120 W Thigpen Ave, Lakeland, GA 31635-1011 | 2014-03-10 |
| 1144270711 | Lanier Health Services, Inc. | General Acute Care Hospital | 116 W Thigpen Ave, Lakeland, GA 31635-1011 | 2006-05-12 |
| 1083122709 | Ashley Exum | Nurse Practitioner | 106 W Thigpen Ave, Lakeland, GA 31635-1011 | 2018-01-16 |
| Find all providers in zip 31635 | ||||
| Taxonomy Code | 3416L0300X |
| Grouping | Transportation Services |
| Classification | Ambulance |
| Specialization | Land Transport |
| Definition to come... |
| Notes: [1/1/2005: title modified] |
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|---|---|---|---|---|
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.