Healthcare Provider Details

I. General information

NPI: 1720163090
Provider Name (Legal Business Name): FAYETTE MEDICAL CENTER AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 TEMPLE AVE N
FAYETTE AL
35555-1314
US

IV. Provider business mailing address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

V. Phone/Fax

Practice location:
  • Phone: 205-343-8500
  • Fax: 205-759-6397
Mailing address:
  • Phone: 205-343-8500
  • Fax: 205-759-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number226
License Number StateAL

VIII. Authorized Official

Name: KERI H HINDMAN
Title or Position: PAITENT ACCOUNTS DIRECTOR
Credential:
Phone: 205-759-7379