1386947901 NPI number — LIFEGUARD AMBULANCE SERVICE OF ALABAMA LLC

Table of content: (NPI 1386947901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386947901 NPI number — LIFEGUARD AMBULANCE SERVICE OF ALABAMA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEGUARD AMBULANCE SERVICE OF ALABAMA LLC
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:
Provider Other Organization Name Type Code:
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:
1386947901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35219-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 WALTER DAVIS DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-380-2065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROCHE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-949-1719

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  831 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X , with the licence number: 971 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 128069 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1528067881 . This is a "TRICARE-SOUTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51121572 . This is a "BCBS-AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 05373267 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108334 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136373 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51550455 . This is a "BCBS-AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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