Healthcare Provider Details

I. General information

NPI: 1194737460
Provider Name (Legal Business Name): HAYNES AMBULANCE OF ALABAMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 E 5TH ST
MONTGOMERY AL
36107-3106
US

IV. Provider business mailing address

PO BOX 1515
WETUMPKA AL
36092-0028
US

V. Phone/Fax

Practice location:
  • Phone: 334-265-1208
  • Fax:
Mailing address:
  • Phone: 334-265-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0267
License Number StateAL

VIII. Authorized Official

Name: MRS. BRANDEE HAYNES BARRETT
Title or Position: DIRECTOR OF BILLING
Credential: EMT-P
Phone: 334-241-5224