Healthcare Provider Details

I. General information

NPI: 1962725226
Provider Name (Legal Business Name): CITY OF GRAYSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 S MAIN ST
GRAYSVILLE AL
35073-1413
US

IV. Provider business mailing address

PO BOX 361706
HOOVER AL
35236-1706
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number248
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number248
License Number StateAL

VIII. Authorized Official

Name: MICHAEL A BARTLETT
Title or Position: ASST FIRE CHIEF
Credential:
Phone: 205-823-7076