Healthcare Provider Details

I. General information

NPI: 1538485040
Provider Name (Legal Business Name): BILLY GEROME CHANCEY PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 8450 2ND AVE
FT. RUCKER AL
36362
US

IV. Provider business mailing address

4 S WISE ST
SAMSON AL
36477-1339
US

V. Phone/Fax

Practice location:
  • Phone: 334-255-3570
  • Fax:
Mailing address:
  • Phone: 334-726-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number9701224
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: