Healthcare Provider Details

I. General information

NPI: 1154389971
Provider Name (Legal Business Name): EXTENDED EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 LAKESIDE DR
MOBILE AL
36693-5113
US

IV. Provider business mailing address

PO BOX 1497
VERNON AL
35592-1497
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-0061
  • Fax: 251-662-8205
Mailing address:
  • Phone: 205-695-9800
  • Fax: 205-695-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number764
License Number StateAL

VIII. Authorized Official

Name: LARRY LUNAN
Title or Position: CEO
Credential:
Phone: 205-695-9800