Healthcare Provider Details

I. General information

NPI: 1154470961
Provider Name (Legal Business Name): CITY OF TRUSSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST
TRUSSVILLE AL
35173-1434
US

IV. Provider business mailing address

PO BOX 361706
BIRMINGHAM AL
35236-1706
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-7478
  • Fax: 205-856-8498
Mailing address:
  • Phone: 205-823-7076
  • Fax: 205-978-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3679
License Number StateAL

VIII. Authorized Official

Name: TIMOTHY CLAYTON SHOTTS
Title or Position: FIRE CHIEF
Credential:
Phone: 205-823-7076