CMS-1500 Box 24J / 33a • NPI
1205112752
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
3416L0300X (CMS 59)
Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance
Box 32 Service Location & ZIP+4
363 BALDWIN RD, CORNELIA, GA, 30531-5785
✓ 9-Digit EDI 837 ZIP+4 (30531-5785)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1205112752 (LIFECARE EMS OF GEORGIA, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1205112752 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | LIFECARE EMS OF GEORGIA, LLC |
| Plain-English Specialty | Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance NUCC Code: 3416L0300X (Ambulance, Land Transport) |
| Certifying / Licensing Body | State EMS Authority / National Registry of Emergency Medical Technicians (NREMT) |
| Practice Location Address | 363 BALDWIN RD, CORNELIA, GA, 30531-5785 |
| Practice Telephone / Fax | Tel: (706) 754-0295 | Fax: (706) 245-6187 |
| Administrative Mailing Address | PO BOX 5860, ATHENS, GA, 30604-5860 |
| Enumeration & Last Sync | Enumerated: 2011-10-28 | CMS Record Updated: 2024-04-22 |
| Authorized Official | BRIAN HANEY (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (3416L0300X)
What Does Taxonomy Code 3416L0300X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3416L0300X translates to:
"Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (LIFECARE EMS OF GEORGIA, LLC)
Typical CPT / Diagnostic Procedures:- Advanced Life Support (ALS) Pre-Hospital Cardiac Monitoring & Defibrillation
- Pre-Hospital Trauma Immobilization, Airway Management & IV Access
- Pre-Hospital Epinephrine, Aspirin, Nitroglycerin, Naloxone & Albuterol
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
3416L0300X — Ambulance, Land TransportPlain English: Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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