1124103312 NPI number — NORTHWEST EMS INC.

Table of content: (NPI 1124103312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124103312 NPI number — NORTHWEST EMS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST EMS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHIL CAMPBELL RESCUE SQUAD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124103312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHIL CAMPBELL
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35581-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-993-4242
Provider Business Mailing Address Fax Number:
256-331-6363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3520 BROAD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHIL CAMPBELL
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35581-3646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-993-4242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POUNDERS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-331-4662

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  584 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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