| Organization Name: | BLUE CROSS EMS LLC |
| NPI Number: | 1427410208 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KYLE MITCHELL BREWER (CEO) |
| Mailing Address: | 3 Pine Grove Dr Locust Grove |
| State: | GA US |
| Postal Code: | 302482561 |
| Phone Number: | 4045209009 |
| Fax Number: | 6787823222 |
| NPI Enumeration Date: | 03/22/2016 |
| NPI Last Update Date: | 03/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | AMB2016005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |