Healthcare Provider Details

I. General information

NPI: 1306896576
Provider Name (Legal Business Name): FOUNTAIN AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5237 HALLS MILL RD BUILDING D
MOBILE AL
36619-9603
US

IV. Provider business mailing address

PO BOX 198408
ATLANTA GA
30384-8408
US

V. Phone/Fax

Practice location:
  • Phone: 251-478-7200
  • Fax: 251-478-3888
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MARK BRUNING
Title or Position: PRESIDENT
Credential:
Phone: 303-495-1220