Healthcare Provider Details

I. General information

NPI: 1285707737
Provider Name (Legal Business Name): CITY OF MILLBROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 GRANDVIEW ROAD
MILLBROOK AL
36054
US

IV. Provider business mailing address

PO BOX 630
MILLBROOK AL
36054-0013
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-6707
  • Fax: 334-285-0307
Mailing address:
  • Phone: 334-285-6707
  • Fax: 334-285-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number308
License Number StateAL

VIII. Authorized Official

Name: MR. LARRY RUSSELL BROWN
Title or Position: FIRE CHIEF
Credential:
Phone: 334-285-6707