Healthcare Provider Details

I. General information

NPI: 1184430209
Provider Name (Legal Business Name): TOWN OF BLOUNTSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68053 MAIN ST
BLOUNTSVILLE AL
35031-3361
US

IV. Provider business mailing address

PO BOX 361706
BIRMINGHAM AL
35236-1706
US

V. Phone/Fax

Practice location:
  • Phone: 205-572-5497
  • Fax:
Mailing address:
  • Phone: 205-823-7076
  • Fax: 205-978-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB DEWAYNE MIKELL
Title or Position: DEPUTY CHIEF
Credential:
Phone: 205-572-5497