Healthcare Provider Details

I. General information

NPI: 1548246010
Provider Name (Legal Business Name): LAWRENCE COUNTY EMERGENCY MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11227 AL HIGHWAY 157 SUITE A
MOULTON AL
35650-1983
US

IV. Provider business mailing address

PO BOX 520
MOULTON AL
35650-0520
US

V. Phone/Fax

Practice location:
  • Phone: 256-974-3711
  • Fax: 256-974-7956
Mailing address:
  • Phone: 256-974-3711
  • Fax: 256-974-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number725
License Number StateAL

VIII. Authorized Official

Name: MR. GREGORY DAREL RANDOLPH
Title or Position: PRESIDENT
Credential: PARAMEDIC
Phone: 256-974-3711