Healthcare Provider Details

I. General information

NPI: 1073871836
Provider Name (Legal Business Name): SHOALS AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 3RD AVE N STE 307
BESSEMER AL
35020-4900
US

IV. Provider business mailing address

PO BOX 660882
DALLAS TX
75266-0882
US

V. Phone/Fax

Practice location:
  • Phone: 844-597-4911
  • Fax:
Mailing address:
  • Phone: 844-597-4911
  • Fax: 866-687-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1032
License Number StateAL

VIII. Authorized Official

Name: ROBERT A JEWELL
Title or Position: CHIEF REVENUE INTEGRATION OFFICER
Credential:
Phone: 844-597-4911