Healthcare Provider Details

I. General information

NPI: 1770059800
Provider Name (Legal Business Name): HAYNES AMBULANCE OF MACON COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WRIGHT ST
TUSKEGEE AL
36083-1558
US

IV. Provider business mailing address

PO BOX 1515
WETUMPKA AL
36092-0028
US

V. Phone/Fax

Practice location:
  • Phone: 334-241-5224
  • Fax:
Mailing address:
  • Phone: 334-241-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: BRANDEE BARRETT
Title or Position: VICE PRESIDENT
Credential:
Phone: 334-241-5224