Healthcare Provider Details

I. General information

NPI: 1578537163
Provider Name (Legal Business Name): PICKENS CO AMBULANCE SRVC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FIRE HOUSE DR
CARROLLTON AL
35447-8002
US

IV. Provider business mailing address

PO BOX 2788
TUSCALOOSA AL
35403-2788
US

V. Phone/Fax

Practice location:
  • Phone: 205-367-8086
  • Fax: 205-345-7911
Mailing address:
  • Phone: 205-752-5866
  • Fax: 205-345-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number344
License Number StateAL

VIII. Authorized Official

Name: JON ANTHONY SMELLEY
Title or Position: CEO
Credential:
Phone: 205-247-4748