Provider Demographics
NPI:1679606040
Name:ANGEL EMS LLC
Entity type:Organization
Organization Name:ANGEL EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-861-1234
Mailing Address - Street 1:337 S CEDAR LN
Mailing Address - Street 2:PO BOX 5495
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3378
Mailing Address - Country:US
Mailing Address - Phone:706-861-1234
Mailing Address - Fax:706-375-8209
Practice Address - Street 1:337 S CEDAR LN
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3378
Practice Address - Country:US
Practice Address - Phone:706-861-1234
Practice Address - Fax:706-375-8209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023-05341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52665555OtherBLUE CROSS BLUE SHEILD
TN4002438OtherBLUE CROSS BLUE SHEILD
GA590012945OtherUNITED HEALTH CARE
TN1430581OtherHEALTHSPRING
TN4582291Medicaid
GA000823259AMedicaid
TN81016OtherAETNA
TN4117030OtherTENN CARE
GA59RCBNDMedicare ID - Type UnspecifiedPROVIDER NUMBER
GA000823259AMedicaid